MEDICARE: DR. KEELY PUCHALSKI ND

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	175F00000X	Naturopath	21-1951	AZ

General Provider Information

NPI Number	:	1538838172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEELY PUCHALSKI ND

Provider Business Mailing Address
First Line	:	1489 W ELLIOT RD STE 103
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85233-5168
Country	:	US
Telephone Number	:	480-256-2999
Fax Number	:	480-520-4050

Provider Business Practice Location Address
First Line	:	1489 W ELLIOT RD STE 103
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85233-5168
Country	:	US
Telephone Number	:	480-256-2999
Fax Number	:	480-520-4050

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

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	12/30/2025

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