MEDICARE: MARILYN M KUNTZ-SIMPSON PA-C, MHSC

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	363A00000X	Physician Assistant	1895	AZ

General Provider Information

NPI Number	:	1811953961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN M KUNTZ-SIMPSON PA-C, MHSC

Provider Business Mailing Address
First Line	:	20401 N 73RD ST STE 255
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-4147
Country	:	US
Telephone Number	:	480-323-1880
Fax Number	:	480-905-1136

Provider Business Practice Location Address
First Line	:	20401 N 73RD ST STE 255
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-4147
Country	:	US
Telephone Number	:	480-323-1880
Fax Number	:	480-905-1136

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	10/06/2015

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