Provider Demographics
NPI:1679557334
Name:CHAROCHAK, JOHN STEVEN (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:STEVEN
Last Name:CHAROCHAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 W. BELL RD SUITE 101A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-3000
Mailing Address - Country:US
Mailing Address - Phone:602-375-3333
Mailing Address - Fax:602-375-0475
Practice Address - Street 1:3033 W BELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-3000
Practice Address - Country:US
Practice Address - Phone:602-375-3333
Practice Address - Fax:602-375-0475
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2333204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0220300OtherBLUE CROSS
AZAZ0220300OtherBLUE CROSS
BCNSZMedicare ID - Type Unspecified