MEDICARE: MICHAEL DOUGLAS SEFCIK DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	372	NM

General Provider Information

NPI Number	:	1699039297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DOUGLAS SEFCIK DPM

Provider Business Mailing Address
First Line	:	1135 N SOLANO DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-2349
Country	:	US
Telephone Number	:	575-526-6103
Fax Number	:	575-526-6347

Provider Business Practice Location Address
First Line	:	1135 N SOLANO DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-2349
Country	:	US
Telephone Number	:	575-526-6103
Fax Number	:	575-526-6347

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

Provider Enumeration Date	:	06/28/2012
Last Update Date	:	07/21/2022

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