Healthcare Provider Details

I. General information

NPI: 1558871582
Provider Name (Legal Business Name): PARKWAY MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10046 N METRO PKWY W STE 115
PHOENIX AZ
85051-1411
US

IV. Provider business mailing address

3724 N 3RD ST STE 301
PHOENIX AZ
85012-2035
US

V. Phone/Fax

Practice location:
  • Phone: 602-674-5515
  • Fax: 602-674-5515
Mailing address:
  • Phone: 480-331-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL SIEFRIED
Title or Position: SOLE MBR
Credential: DC
Phone: 602-674-5515