Provider Demographics
NPI:1578588315
Name:BOBIK, DENNIS ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ROBERT
Last Name:BOBIK
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 1:2345 E THOMAS RD
Mailing Address - Street 2:SUITE # 420
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7848
Mailing Address - Country:US
Mailing Address - Phone:602-955-5700
Mailing Address - Fax:602-955-5701
Practice Address - Street 1:2345 E THOMAS RD
Practice Address - Street 2:SUITE # 420
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7848
Practice Address - Country:US
Practice Address - Phone:602-955-5700
Practice Address - Fax:602-955-5701
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002015L213E00000X
AZ731213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000318Medicare ID - Type Unspecified
PA000318Medicare PIN
PAT72350Medicare UPIN