MEDICARE: KAIZEN MEDICAL GROUP PLLC

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	208100000X	Physical Medicine & Rehabilitation Physician	2830	AZ

General Provider Information

NPI Number	:	1427508746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAIZEN MEDICAL GROUP PLLC

Provider Business Mailing Address
First Line	:	15300 N 90TH ST
Second Line	:	SUITE 950
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-2771
Country	:	US
Telephone Number	:	480-941-2147
Fax Number	:	480-941-2157

Provider Business Practice Location Address
First Line	:	15300 N 90TH ST
Second Line	:	SUITE 950
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-2771
Country	:	US
Telephone Number	:	480-941-2147
Fax Number	:	480-941-2157

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ROBIN MACDOUGALL
Credential	:
Telephone Number	:	480-941-2147

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	05/01/2017

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