MEDICARE: CRAIG L. MECHELKE, D.O., LTD.

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1043410723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAIG L. MECHELKE, D.O., LTD.

Provider Business Mailing Address
First Line	:	4915 E BASELINE RD
Second Line	:	SUITE 126
City	:	GILBERT
State	:	AZ
Zip	:	85234-2965
Country	:	US
Telephone Number	:	480-969-3096
Fax Number	:	480-969-0963

Provider Business Practice Location Address
First Line	:	4915 E BASELINE RD
Second Line	:	SUITE 126
City	:	GILBERT
State	:	AZ
Zip	:	85234-2965
Country	:	US
Telephone Number	:	480-969-3096
Fax Number	:	480-969-0963

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CRAIG LOREN MECHELKE
Credential	:	D.O.
Telephone Number	:	480-969-3096

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/20/2007

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