Provider Demographics
NPI:1306851977
Name:UHRIK, OTTO (MD)
Entity Type:Individual
Prefix:
First Name:OTTO
Middle Name:
Last Name:UHRIK
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 1:10228 W COGGINS DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3421
Mailing Address - Country:US
Mailing Address - Phone:623-214-8800
Mailing Address - Fax:623-214-3446
Practice Address - Street 1:10228 W COGGINS DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3421
Practice Address - Country:US
Practice Address - Phone:623-214-8800
Practice Address - Fax:623-214-3446
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29559208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ592742Medicaid
69172Medicare ID - Type Unspecified
AZ592742Medicaid