Healthcare Provider Details

I. General information

NPI: 1306782958
Provider Name (Legal Business Name): THOMAS LEON ZYWCZYK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 W CAMELBACK RD
PHOENIX AZ
85017-1097
US

IV. Provider business mailing address

2427 W TURTLE HILL DR
ANTHEM AZ
85086-1186
US

V. Phone/Fax

Practice location:
  • Phone: 614-286-8408
  • Fax:
Mailing address:
  • Phone: 614-286-8408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: