Provider Demographics
NPI:1912946591
Name:SWEETEN, KERI M (MD)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:M
Last Name:SWEETEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10255 N 32ND STREET
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028
Mailing Address - Country:US
Mailing Address - Phone:602-393-0661
Mailing Address - Fax:602-254-3474
Practice Address - Street 1:10255 N 32ND STREET
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028
Practice Address - Country:US
Practice Address - Phone:602-393-0661
Practice Address - Fax:602-254-3474
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23505207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ319881Medicaid
AZ77701Medicare ID - Type Unspecified
AZ319881Medicaid