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NPI Code Detail

MEDICARE: YVONNE MARIA FUNCKE MD

MEDICARE: YVONNE MARIA FUNCKE MD
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
1208000000XPediatrics Physician30116AZ

Other Identifiers

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

General Provider Information

NPI Number : 1073505517
Entity Type Code : Individual
Provider Name (Legal Business Name) : YVONNE MARIA FUNCKE MD
Provider Business Mailing Address
First Line : 15650 N BLACK CANYON HWY
Second Line : SUITE 100
City : PHOENIX
State : AZ
Zip : 85053-4064
Country : US
Telephone Number : 602-866-0550
Fax Number : 602-993-5788
Provider Business Practice Location Address
First Line : 15650 N BLACK CANYON HWY
Second Line : SUITE 100
City : PHOENIX
State : AZ
Zip : 85053-4064
Country : US
Telephone Number : 602-866-0550
Fax Number : 602-993-5788
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2005
Last Update Date : 08/22/2011

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Directions to “ YVONNE MARIA FUNCKE MD” Practice Location

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