MEDICARE: KACI RAE LARSEN 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	207Q00000X	Family Medicine Physician	64070	AZ
2	207Q00000X	Family Medicine Physician	2018044700	MO

General Provider Information

NPI Number	:	1437509759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KACI RAE LARSEN MD

Provider Business Mailing Address
First Line	:	25500 N NORTERRA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-8200
Country	:	US
Telephone Number	:	623-277-2370
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 N 12TH ST STE 404
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2866
Country	:	US
Telephone Number	:	800-233-3264
Fax Number	:

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

Provider Enumeration Date	:	06/17/2016
Last Update Date	:	02/09/2026

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Directions to “ KACI RAE LARSEN MD” Practice Location

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