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1235111600

NPI Code Detail

MEDICARE: DR. KENNETH BARRY FLEISCH MD

MEDICARE: DR. KENNETH BARRY FLEISCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	28922	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0728670	OTHER	AZ	BLUECROSS BLUESHIELD GRP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	860373636	OTHER	AZ	HUMANA GRP
4	453051001	OTHER	AZ	GROUP HEALTH GRP
5	3981220	OTHER	AZ	EVERCARE GROUP
6	AW1436	OTHER	AZ	HEALTHNET GRP

General Provider Information

NPI Number	:	1235111600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH BARRY FLEISCH MD

Provider Business Mailing Address
First Line	:	5635 N SCOTTSDALE RD STE 170
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85250-5945
Country	:	US
Telephone Number	:	602-386-9982
Fax Number	:

Provider Business Practice Location Address
First Line	:	5635 N SCOTTSDALE RD STE 170
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85250-5945
Country	:	US
Telephone Number	:	602-386-9982
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	06/13/2013

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Directions to “ DR. KENNETH BARRY FLEISCH MD” Practice Location

Language	Start Address	Practice Location

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