Individual
DR. KENNETH LEE PETTIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
40 S KYRENE RD, SUITE 1, CHANDLER, AZ 85226-4675
(480) 706-0174
(480) 706-0117
Mailing address
40 S KYRENE RD, SUITE 1, CHANDLER, AZ 85226-4675
(480) 706-0174
(480) 706-0117
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3144
AZ
207Q00000X
Family Medicine Physician
E07166
HI
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
3144
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
437609
—
AZ
Enumeration date
06/21/2006
Last updated
09/09/2020
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