MEDICARE: LINDA JOYCE STANEK MD

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	207QS0010X	Sports Medicine (Family Medicine) Physician	67050	AZ
2	207Q00000X	Family Medicine Physician	4301114977	AZ

General Provider Information

NPI Number	:	1619462173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA JOYCE STANEK MD

Provider Business Mailing Address
First Line	:	4720 E GREENWAY RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4355
Country	:	US
Telephone Number	:	602-439-6000
Fax Number	:	602-439-6289

Provider Business Practice Location Address
First Line	:	4720 E GREENWAY RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4355
Country	:	US
Telephone Number	:	602-439-6000
Fax Number	:	602-439-6289

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

Provider Enumeration Date	:	06/27/2018
Last Update Date	:	12/15/2025

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