Provider Demographics
NPI:1447242888
Name:CREZEE, KELVIN S (DPM)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:S
Last Name:CREZEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15810 S 45TH ST
Mailing Address - Street 2:SUITE # 190
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7694
Mailing Address - Country:US
Mailing Address - Phone:480-893-1090
Mailing Address - Fax:480-598-1458
Practice Address - Street 1:15810 S 45TH ST
Practice Address - Street 2:ST #190
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7694
Practice Address - Country:US
Practice Address - Phone:480-893-1090
Practice Address - Fax:480-598-1458
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2008-04-30
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
AZ0328213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ480008406OtherRAILROAD MEDICARE
AZAZ0190620OtherBLUE CROSS BLUE SHIELD
AZ0653000001OtherDMERC
AZZWDCDQ01Medicare PIN
AZ480008406OtherRAILROAD MEDICARE
AZ0653000001OtherDMERC