Provider Demographics
NPI:1235111600
Name:FLEISCH, KENNETH BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:BARRY
Last Name:FLEISCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5635 N SCOTTSDALE RD STE 170
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-5945
Mailing Address - Country:US
Mailing Address - Phone:602-386-9982
Mailing Address - Fax:
Practice Address - Street 1:5635 N SCOTTSDALE RD STE 170
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-5945
Practice Address - Country:US
Practice Address - Phone:602-386-9982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28922207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0728670OtherBLUECROSS BLUESHIELD GRP
AZ148363Medicaid
AZ860373636OtherHUMANA GRP
AZ453051001OtherGROUP HEALTH GRP
AZ3981220OtherEVERCARE GROUP
AZAW1436OtherHEALTHNET GRP
AZ3981220OtherEVERCARE GROUP
AZAW1436OtherHEALTHNET GRP