Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 0320 | AZ |
Y | 222Z00000X | Podiatrist | 0320 | AZ |
NPI | 1063409449 |
---|---|
Provider Name | Michael J Sekosky |
First Address | Fountain Hills, AZ 85268-5537 |
Second Address | Fountain Hills, AZ 85268-5537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 14/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19496603 | (05) | AZ |
AZ0190570 | BLUE CROSS BLUE SHIELD (01) | AZ |
AZ1830 | HEALTH NET (01) | AZ |
T88252 | (02) | AZ |