Healthcare Provider Details

I. General information

NPI: 1487675153
Provider Name (Legal Business Name): MILAN MILOSLAV HRKAL III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21321 E.OCOTILLO RD. STE.110
QUEEN CREEK AZ
85242
US

IV. Provider business mailing address

21321 E OCOTILLO RD STE 110
QUEEN CREEK AZ
85242-5996
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-4545
  • Fax: 480-677-4356
Mailing address:
  • Phone: 480-677-4545
  • Fax: 480-677-4356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36321
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18670
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: