Provider Demographics
NPI:1073505517
Name:FUNCKE, YVONNE MARIA (MD)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:MARIA
Last Name:FUNCKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:MARIA
Other - Last Name:FUNCKE-SANDWEISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15650 N BLACK CANYON HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4064
Mailing Address - Country:US
Mailing Address - Phone:602-866-0550
Mailing Address - Fax:602-993-5788
Practice Address - Street 1:15650 N BLACK CANYON HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4064
Practice Address - Country:US
Practice Address - Phone:602-866-0550
Practice Address - Fax:602-993-5788
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30116208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ704446Medicaid