Provider Demographics
NPI:1114927548
Name:STECYK, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:STECYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10869 N. SCOTTSDALE RD.
Mailing Address - Street 2:#103-180
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254
Mailing Address - Country:US
Mailing Address - Phone:480-991-4555
Mailing Address - Fax:480-483-6550
Practice Address - Street 1:15720 N GREENWAY HAYDEN LOOP
Practice Address - Street 2:SUITE 3
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1796
Practice Address - Country:US
Practice Address - Phone:480-991-4555
Practice Address - Fax:480-483-6550
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ860756258OtherTAX ID
AZE80867Medicare UPIN