Healthcare Provider Details

I. General information

NPI: 1427744424
Provider Name (Legal Business Name): PAWEL LYSIKOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 W THUNDERBIRD RD
GLENDALE AZ
85306-4622
US

IV. Provider business mailing address

5555 W THUNDERBIRD RD
GLENDALE AZ
85306-4622
US

V. Phone/Fax

Practice location:
  • Phone: 602-865-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number80911
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: