MEDICARE: DR. KAREN MARIE ACEVEDO-MOGHARBEL D.O

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	207Q00000X	Family Medicine Physician	3882	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7677424	OTHER	AZ	AETNA
2	1Z9851	OTHER	AZ	HEALTH NET
3	AZ0743320	OTHER	AZ	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	2284444	OTHER	AZ	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1245222074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN MARIE ACEVEDO-MOGHARBEL D.O

Provider Business Mailing Address
First Line	:	3035 S ELLSWORTH RD
Second Line	:	SUITE 103
City	:	MESA
State	:	AZ
Zip	:	85212-2160
Country	:	US
Telephone Number	:	480-736-1777
Fax Number	:	480-736-1144

Provider Business Practice Location Address
First Line	:	3035 S ELLSWORTH RD
Second Line	:	SUITE 103
City	:	MESA
State	:	AZ
Zip	:	85212
Country	:	US
Telephone Number	:	480-736-1777
Fax Number	:	480-736-1144

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	03/09/2009

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