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NPI Code Detail

MEDICARE: NATHANIEL A PTAK

MEDICARE: NATHANIEL A PTAK
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
1207XX0004XOrthopaedic Foot and Ankle Surgery Physician12366058-0501UT
2213ES0103XFoot & Ankle Surgery PodiatristPOD001108AZ

General Provider Information

NPI Number : 1194387571
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHANIEL A PTAK
Provider Business Mailing Address
First Line : 5750 E HIGHWAY 90 STE 200
Second Line :
City : SIERRA VISTA
State : AZ
Zip : 85635-9113
Country : US
Telephone Number : 520-263-3761
Fax Number :
Provider Business Practice Location Address
First Line : 5750 E HIGHWAY 90 STE 200
Second Line :
City : SIERRA VISTA
State : AZ
Zip : 85635-9113
Country : US
Telephone Number : 520-263-3761
Fax Number : 520-263-3779
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2019
Last Update Date : 06/26/2025

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Directions to “ NATHANIEL A PTAK ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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