Healthcare Provider Details

I. General information

NPI: 1982934204
Provider Name (Legal Business Name): CENTER FOR SEXUAL AND URINARY FUNCTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 S SUTTER DR STE 1
SHOW LOW AZ
85901-8055
US

IV. Provider business mailing address

4121 E MISSION LN STE 102
PHOENIX AZ
85028-5403
US

V. Phone/Fax

Practice location:
  • Phone: 623-780-2300
  • Fax: 888-927-0569
Mailing address:
  • Phone: 623-780-2300
  • Fax: 888-927-0569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number34718
License Number StateAZ

VIII. Authorized Official

Name: DR. PETER NIEMCZYK
Title or Position: DIRECTOR
Credential: M.D.
Phone: 602-531-5824