Provider Demographics
NPI:1386843605
Name:TERTEL, KENNETH JOHN II (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JOHN
Last Name:TERTEL
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6890 E SUNRISE DR
Mailing Address - Street 2:#120-220
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-0738
Mailing Address - Country:US
Mailing Address - Phone:520-547-5935
Mailing Address - Fax:520-577-3028
Practice Address - Street 1:6270 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5831
Practice Address - Country:US
Practice Address - Phone:520-547-5935
Practice Address - Fax:520-541-5934
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ208632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF46769Medicare UPIN