Healthcare Provider Details

I. General information

NPI: 1821484171
Provider Name (Legal Business Name): NICHOLAS BUJAK MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4338 W THOMAS RD STE 173
PHOENIX AZ
85031-3878
US

IV. Provider business mailing address

4338 W THOMAS RD STE 173
PHOENIX AZ
85031-3878
US

V. Phone/Fax

Practice location:
  • Phone: 602-429-2239
  • Fax:
Mailing address:
  • Phone: 602-429-2239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. HELEN BUJAK
Title or Position: OFFICE MANAGER
Credential:
Phone: 623-341-2825