MEDICARE: DR. STEFAN MUDRYJ DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	0493	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003859240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEFAN MUDRYJ DPM

Provider Business Mailing Address
First Line	:	PO BOX 50848
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85076-0848
Country	:	US
Telephone Number	:	480-235-5797
Fax Number	:	480-629-5206

Provider Business Practice Location Address
First Line	:	16601 N 40TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3354
Country	:	US
Telephone Number	:	480-235-5797
Fax Number	:	480-629-5206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/09/2007

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