Healthcare Provider Details

I. General information

NPI: 1558848408
Provider Name (Legal Business Name): ZUKAITIS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7878 N 16TH ST STE 250
PHOENIX AZ
85020
US

IV. Provider business mailing address

7878 N 16TH ST STE 250
PHOENIX AZ
85020-4478
US

V. Phone/Fax

Practice location:
  • Phone: 602-395-0718
  • Fax:
Mailing address:
  • Phone: 602-395-0718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES L ZUKAITIS
Title or Position: MD/ SOLE OWNER
Credential: MD
Phone: 602-395-0718