Provider Demographics
NPI:1285658682
Name:YUZAK, BIRSEN
Entity Type:Individual
Prefix:DR
First Name:BIRSEN
Middle Name:
Last Name:YUZAK
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:BIRSEN
Other - Middle Name:
Other - Last Name:DODANLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12440 S SHASTA CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3980
Mailing Address - Country:US
Mailing Address - Phone:480-648-5990
Mailing Address - Fax:
Practice Address - Street 1:12440 S SHASTA CT
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-3980
Practice Address - Country:US
Practice Address - Phone:480-648-5990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01597424Medicaid
13L731Medicare ID - Type Unspecified
F43106Medicare UPIN
BY013L7310Medicare PIN