Provider Demographics
NPI:1457452856
Name:SMIGIEL, KEITH DENNIS (NP)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:DENNIS
Last Name:SMIGIEL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13610 N SCOTTSDALE RD STE 10
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4087
Mailing Address - Country:US
Mailing Address - Phone:602-485-9390
Mailing Address - Fax:
Practice Address - Street 1:13610 N SCOTTSDALE RD STE 10
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4087
Practice Address - Country:US
Practice Address - Phone:602-485-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5513111N00000X
AZAP10952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU559361Medicare UPIN