Healthcare Provider Details

I. General information

NPI: 1801821152
Provider Name (Legal Business Name): TODD MICHAEL HRABAK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 W. THUNDERBIRD RD #G780
GLENDALE AZ
85306-4636
US

IV. Provider business mailing address

13634 N 93RD AVE #100
PEORIA AZ
85381-4248
US

V. Phone/Fax

Practice location:
  • Phone: 602-314-4220
  • Fax: 602-788-1890
Mailing address:
  • Phone: 623-933-0301
  • Fax: 623-933-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number4812
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: