Healthcare Provider Details

I. General information

NPI: 1255423539
Provider Name (Legal Business Name): DIANE ELIZABETH HLAVACEK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANE ELIZABETH ROBINSON MD

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16641 N 40TH STREET SUITE 2
PHOENIX AZ
85032-3343
US

IV. Provider business mailing address

16641 N 40TH STREET SUITE 2
PHOENIX AZ
85032-3343
US

V. Phone/Fax

Practice location:
  • Phone: 602-482-2929
  • Fax: 602-482-4976
Mailing address:
  • Phone: 602-482-2929
  • Fax: 602-482-4976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberAZ31335
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: