Provider Demographics
NPI:1083882286
Name:ROGER J. HUCEK, M.D., INC.
Entity Type:Organization
Organization Name:ROGER J. HUCEK, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENZANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-547-1623
Mailing Address - Street 1:5620 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE E-1
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4636
Mailing Address - Country:US
Mailing Address - Phone:602-547-1623
Mailing Address - Fax:602-547-1767
Practice Address - Street 1:5620 W THUNDERBIRD RD
Practice Address - Street 2:SUITE E-1
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4636
Practice Address - Country:US
Practice Address - Phone:602-547-1623
Practice Address - Fax:602-547-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19766174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ044967Medicaid
AZC02162Medicare UPIN
AZ71348Medicare PIN