Provider Demographics
NPI:1366418675
Name:KRESL, JOHN J (MD, PHD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:KRESL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 E. SHEA BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4254
Mailing Address - Country:US
Mailing Address - Phone:602-441-3845
Mailing Address - Fax:602-464-9769
Practice Address - Street 1:4611 E. SHEA BLVD
Practice Address - Street 2:STE. 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4254
Practice Address - Country:US
Practice Address - Phone:602-441-3845
Practice Address - Fax:602-464-9769
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ257032085R0202X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ395071OtherAHCCCS
AZZ126888Medicare UPIN
AZZ24460Medicare PIN
AZZ126789Medicare PIN
AZF88693Medicare UPIN