Provider Demographics
NPI:1427508746
Name:KAIZEN MEDICAL GROUP PLLC
Entity type:Organization
Organization Name:KAIZEN MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MACDOUGALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-941-2147
Mailing Address - Street 1:15300 N 90TH ST
Mailing Address - Street 2:SUITE 950
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2771
Mailing Address - Country:US
Mailing Address - Phone:480-941-2147
Mailing Address - Fax:480-941-2157
Practice Address - Street 1:15300 N 90TH ST
Practice Address - Street 2:SUITE 950
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2771
Practice Address - Country:US
Practice Address - Phone:480-941-2147
Practice Address - Fax:480-941-2157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2830208100000X, 207QS0010X
AZ3359363A00000X
AZ3303363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty