Provider Demographics
NPI:1699039297
Name:SEFCIK, MICHAEL DOUGLAS (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:SEFCIK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 N SOLANO DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-2349
Mailing Address - Country:US
Mailing Address - Phone:575-526-6103
Mailing Address - Fax:575-526-6347
Practice Address - Street 1:1135 N SOLANO DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-2349
Practice Address - Country:US
Practice Address - Phone:575-526-6103
Practice Address - Fax:575-526-6347
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM372213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery