Provider Demographics
NPI:1841230976
Name:KO, WILLIAM T (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:T
Last Name:KO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 W NORTHERN AVE STE D300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5099
Mailing Address - Country:US
Mailing Address - Phone:602-277-1449
Mailing Address - Fax:602-277-9984
Practice Address - Street 1:2224 W NORTHERN AVE STE D300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021
Practice Address - Country:US
Practice Address - Phone:602-277-1449
Practice Address - Fax:602-277-9984
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26333207ND0101X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0873220OtherBLUE CROSS
AZ686868Medicaid
AZ8009018002OtherCIGNA
AZ007180050OtherAETNA
AZ070015308OtherRAILROAD MEDICARE
AZ2Z2527OtherHEALTHNET
AZ62357Medicare ID - Type UnspecifiedPV LOCATION
AZ070015308OtherRAILROAD MEDICARE
AZ686868Medicaid