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General NPI Number Information
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NPI Number | 1649112517
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Entity Type | Organization
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Legal Business Name | PROXY MEDICAL GROUP PC
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Dates
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Enumeration Date | 04/08/2026
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Last Update Date | 04/08/2026
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Provider Practice Location Address
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Address Line | 101 E WASHINGTON ST
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City | PHOENIX
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State | AZ
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Zip | 85004-2960
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Country | US
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Telephone | 734-707-7893
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Fax |
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Provider Business Mailing Address
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Address Line | 4539 N 22ND ST STE R
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City | PHOENIX
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State | AZ
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Zip | 85016-4639
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IGOR SHKOLNIK
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Credential | MD
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Telephone | 734-707-7893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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