Provider Demographics
NPI:1467432815
Name:CWIK, CHRISTOPHER S (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:S
Last Name:CWIK
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 1:9059 W. LAKE PLEASANT PKWY
Mailing Address - Street 2:STE E-540
Mailing Address - City:PEORLA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382
Mailing Address - Country:US
Mailing Address - Phone:623-322-3380
Mailing Address - Fax:623-322-4399
Practice Address - Street 1:9305 W THOMAS RD
Practice Address - Street 2:STE 125
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3328
Practice Address - Country:US
Practice Address - Phone:623-388-3216
Practice Address - Fax:623-388-4902
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37360208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4434626Medicaid
AZ258231Medicaid
AZ258231Medicaid
MI4434626Medicaid