Healthcare Provider Details

I. General information

NPI: 1679557334
Provider Name (Legal Business Name): JOHN STEVEN CHAROCHAK D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 W BELL RD
PHOENIX AZ
85053-3000
US

IV. Provider business mailing address

3033 W. BELL RD SUITE 101A
PHOENIX AZ
85053-3000
US

V. Phone/Fax

Practice location:
  • Phone: 602-375-3333
  • Fax: 602-375-0475
Mailing address:
  • Phone: 602-375-3333
  • Fax: 602-375-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number2333
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: