Healthcare Provider Details

I. General information

NPI: 1386848547
Provider Name (Legal Business Name): HOWARD CHARLES PITLUK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 E CAMELBACK RD #804
PHOENIX AZ
85016-9033
US

IV. Provider business mailing address

2211 E CAMELBACK RD #804
PHOENIX AZ
85016-9033
US

V. Phone/Fax

Practice location:
  • Phone: 602-665-6143
  • Fax:
Mailing address:
  • Phone: 602-665-6143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number23149
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number23149
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: