Provider Demographics
NPI:1477543486
Name:SISTEK, MARCIA L (MD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
Last Name:SISTEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9755 N 90TH ST
Mailing Address - Street 2:SUITE C-200
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5046
Mailing Address - Country:US
Mailing Address - Phone:480-661-1755
Mailing Address - Fax:480-661-9636
Practice Address - Street 1:9755 N 90TH ST
Practice Address - Street 2:SUITE C-200
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5046
Practice Address - Country:US
Practice Address - Phone:480-661-1755
Practice Address - Fax:480-661-9636
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2016-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ22864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG21194Medicare UPIN
AZ60866Medicare ID - Type Unspecified