Provider Demographics
NPI:1649265315
Name:STERUSKY, MARTIN G (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:G
Last Name:STERUSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12361 W BOLA DR
Mailing Address - Street 2:SUITE100
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-9021
Mailing Address - Country:US
Mailing Address - Phone:623-584-5626
Mailing Address - Fax:623-584-8998
Practice Address - Street 1:12361 W BOLA DR
Practice Address - Street 2:SUITE100
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9021
Practice Address - Country:US
Practice Address - Phone:623-584-5626
Practice Address - Fax:623-584-8998
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11425207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ200009435OtherRAILROAD MEDICARE
AZ230805Medicaid
AZ1649265315OtherAHCCCS
AZ2Z3173OtherHEALTH NET
AZ732348OtherUNITED HEALTHCARE
AZ1649265315OtherBCBS AZ OUT OF AREA
AZ4399835OtherAETNA
AZ2Z3173OtherHEALTH NET
AZ1649265315OtherAHCCCS
AZ732348OtherUNITED HEALTHCARE
AZZWCLCJMedicare PIN