Healthcare Provider Details

I. General information

NPI: 1174503478
Provider Name (Legal Business Name): BERNARD MICHAEL GBUREK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17300 N PERIMETER DR STE 220
SCOTTSDALE AZ
85255-6703
US

IV. Provider business mailing address

10200 GRAND CENTRAL AVE STE 220
OWINGS MILLS MD
21117-4366
US

V. Phone/Fax

Practice location:
  • Phone: 480-661-2662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number26312
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: