Provider Demographics
NPI:1356319982
Name:STAHL, KEVIN ANN (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ANN
Last Name:STAHL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15030 N HAYDEN RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2579
Mailing Address - Country:US
Mailing Address - Phone:602-494-8105
Mailing Address - Fax:602-494-8108
Practice Address - Street 1:15615 N. 71ST STREET
Practice Address - Street 2:SUITE 108
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254
Practice Address - Country:US
Practice Address - Phone:602-494-8105
Practice Address - Fax:602-494-8108
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ231292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ430744Medicaid
571377Medicare PIN
81612Medicare ID - Type Unspecified
AZZ140162Medicare PIN
AZZ100458Medicare PIN
AZ430744Medicaid