MEDICARE: DR. SAMUEL IRWIN DOLNICK D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	0377	AZ

General Provider Information

NPI Number	:	1073506259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL IRWIN DOLNICK D.P.M.

Provider Business Mailing Address
First Line	:	3035 RAINBOW RIDGE DR
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86303-5766
Country	:	US
Telephone Number	:	928-443-1712
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N US HIGHWAY 89
Second Line	:	5TH FLOOR SURGERY
City	:	PRESCOTT
State	:	AZ
Zip	:	86313-5001
Country	:	US
Telephone Number	:	928-445-4860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/08/2007

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