MEDICARE: CORNERSTONE GERIATRIC CARE, PC

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	46497	AZ

General Provider Information

NPI Number	:	1568869048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE GERIATRIC CARE, PC

Provider Business Mailing Address
First Line	:	21846 N 21ST AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-2003
Country	:	US
Telephone Number	:	623-535-5887
Fax Number	:	602-429-8112

Provider Business Practice Location Address
First Line	:	6740 W DEER VALLEY RD
Second Line	:	PMB 304
City	:	GLENDALE
State	:	AZ
Zip	:	85310-5953
Country	:	US
Telephone Number	:	623-535-5887
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MATTHEW D SKINNER
Credential	:	MD
Telephone Number	:	623-535-5887

Provider Enumeration Date	:	11/26/2014
Last Update Date	:	11/30/2014

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