Provider Demographics
NPI:1487649778
Name:SEKOSKY, TIMOTHY (DPM)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:SEKOSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8837
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-0130
Mailing Address - Country:US
Mailing Address - Phone:602-938-8400
Mailing Address - Fax:602-938-8401
Practice Address - Street 1:3201 W PEORIA AVE
Practice Address - Street 2:SUITE B307
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4608
Practice Address - Country:US
Practice Address - Phone:602-938-8400
Practice Address - Fax:602-938-8401
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2008-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0472213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ398330001Medicaid
AZZ67546Medicare PIN
AZU66292Medicare UPIN