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Individual
MR. KEVIN MICHAEL FORDELL
Active
Individual
MR. KEVIN MICHAEL FORDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4295
AZ
363A00000X
Physician Assistant
4295
AZ
Other
Enumeration date
09/22/2008
Last updated
03/01/2023
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