Individual
MR. KEVIN MICHAEL FORDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
2550 N THUNDERBIRD CIR STE 303, MESA, AZ 85215-1219
(480) 924-8382
(480) 924-8399
Mailing address
645 E MISSOURI AVE STE 300, PHOENIX, AZ 85012-1351
(602) 502-4621
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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