Provider Demographics
NPI:1114994951
Name:REDTFELDT, RAQUEL A (MD)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:A
Last Name:REDTFELDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 E BASELINE RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4412
Mailing Address - Country:US
Mailing Address - Phone:480-273-8680
Mailing Address - Fax:480-306-7683
Practice Address - Street 1:4140 E BASELINE RD
Practice Address - Street 2:SUITE 211
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4412
Practice Address - Country:US
Practice Address - Phone:480-273-8680
Practice Address - Fax:480-306-7683
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31550207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ31550OtherLICENSE
H63980Medicare UPIN
74754Medicare ID - Type Unspecified
AZ31550OtherLICENSE