Healthcare Provider Details

I. General information

NPI: 1225008931
Provider Name (Legal Business Name): JAMES LEO ZUKAITIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 E SOUTHERN AVE STE 7
TEMPE AZ
85282-7612
US

IV. Provider business mailing address

PO BOX 41150
MESA AZ
85274
US

V. Phone/Fax

Practice location:
  • Phone: 602-744-4765
  • Fax: 602-744-4799
Mailing address:
  • Phone: 480-353-7619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number19673
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: