MEDICARE: DR. KENNETH R HOFSTETTER M.D.

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	2085R0202X	Diagnostic Radiology Physician	6321	AZ
2	2085N0904X	Nuclear Radiology Physician	6321	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	244947	OTHER	AZ	AHCCCS
2	1Z7049	OTHER	AZ	HEALTHNET
3	AZ0324990	OTHER	AZ	BCBS

General Provider Information

NPI Number	:	1891753091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH R HOFSTETTER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 14687
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85267-4687
Country	:	US
Telephone Number	:	480-991-8100
Fax Number	:	480-922-1028

Provider Business Practice Location Address
First Line	:	11209 N TATUM BLVD
Second Line	:	SUITE # 110
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3091
Country	:	US
Telephone Number	:	602-248-8002
Fax Number	:	602-248-8399

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	04/30/2026

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Directions to “ DR. KENNETH R HOFSTETTER M.D.” Practice Location

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