Individual
DR. KEVIN JOHN HASELHORST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13677 W MCDOWELL RD, GOODYEAR, AZ 85338-2618
(623) 882-1500
Mailing address
5777 N 78TH PL, SCOTTSDALE, AZ 85250-6170
(480) 947-9682
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
25725
AZ
208D00000X
General Practice Physician
Primary
25725
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3981220
EVERCARE GROUP
AZ
05
—
420886
—
AZ
01
—
453051001
GROUP HEALTH GROUP
AZ
01
—
860373636
HUMANA-GROUP #
AZ
01
—
AW1436
HEALTHNET GROUP
AZ
01
—
AZ0728670
BLUE CROSS BLUE SHIELD-GR
AZ
Enumeration date
11/07/2005
Last updated
09/28/2021
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