Provider Demographics
NPI:1578094603
Name:SZYMASZEK-CUSICK, MARTA KAROLINA (MD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:KAROLINA
Last Name:SZYMASZEK-CUSICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13995 W STATLER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-5503
Mailing Address - Country:US
Mailing Address - Phone:623-478-3100
Mailing Address - Fax:623-478-3300
Practice Address - Street 1:13995 W STATLER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-5503
Practice Address - Country:US
Practice Address - Phone:623-478-3100
Practice Address - Fax:623-478-3300
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ61185208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program