Provider Demographics
NPI:1235130980
Name:SCAVETTA, KAREN L (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:SCAVETTA
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 1:28150 N ALMA SCHOOL PKWY STE 103
Mailing Address - Street 2:PMB #311
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-8049
Mailing Address - Country:US
Mailing Address - Phone:480-614-0460
Mailing Address - Fax:480-614-0461
Practice Address - Street 1:34597 N 60TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-5240
Practice Address - Country:US
Practice Address - Phone:480-614-0460
Practice Address - Fax:480-614-0461
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28691207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ767634Medicaid
Z144747Medicare PIN
AZG37328Medicare UPIN
AZ103431Medicare ID - Type UnspecifiedMARICOPA COUNTY
AZ103430Medicare ID - Type UnspecifiedYAVAPAI COUNTY
AZ767634Medicaid
AZZ147716Medicare PIN