Individual
DR. KENNETH JOHN BESCAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
294 W STATE ROUTE 89A, SUITE 107, COTTONWOOD, AZ 86326-3754
(928) 634-1331
(928) 634-3130
Mailing address
1200 N BEAVER ST, PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
35036051
OH
207RC0000X
Cardiovascular Disease Physician
Primary
40903
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000128703
ANTHEM
OH
05
—
0413832
—
OH
01
—
060013315
RAILROAD MEDICARE #
—
01
—
100402
KAISER
OH
01
—
341221800045
CARESOURCE
OH
05
—
413507
—
AZ
01
—
E36051
SUMMA
OH
Enumeration date
01/13/2006
Last updated
11/04/2016
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