Individual
DR. KENNETH JOSEPH PREBIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14155 N 83RD AVE STE A105, PEORIA, AZ 85381-5640
(623) 486-7700
Mailing address
14155 N. 83RD AVE., STE. A-105, PEORIA, AZ 85381
(623) 486-7700
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
5770
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
225319
—
AZ
01
—
AZ0053950
BLUE CROSS BLUE SHIELD ID
AZ
Enumeration date
04/04/2006
Last updated
08/15/2008
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