Healthcare Provider Details

I. General information

NPI: 1013104843
Provider Name (Legal Business Name): DONALD E. CHUDY, DPM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 E BASELINE RD SUITE 107
MESA AZ
85206-4676
US

IV. Provider business mailing address

4824 E BASELINE RD SUITE 107
MESA AZ
85206-4676
US

V. Phone/Fax

Practice location:
  • Phone: 480-964-1715
  • Fax: 480-834-5525
Mailing address:
  • Phone: 480-964-1715
  • Fax: 480-834-5525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0202
License Number StateAZ

VIII. Authorized Official

Name: MRS. SUSAN L CHUDY
Title or Position: OFFICE SUPERVISOR
Credential:
Phone: 480-964-1715