Provider Demographics
NPI:1912168410
Name:SAGUARO PODIATRY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:SAGUARO PODIATRY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LADISLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:520-417-2244
Mailing Address - Street 1:4810 E HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2440
Mailing Address - Country:US
Mailing Address - Phone:520-417-2244
Mailing Address - Fax:520-459-0487
Practice Address - Street 1:4810 E HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2440
Practice Address - Country:US
Practice Address - Phone:520-417-2244
Practice Address - Fax:520-459-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ359656Medicaid