MEDICARE: DOROTA E PUCYK M.D.

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	43712	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z141578	OTHER	AZ	MEDICARE PTAN

General Provider Information

NPI Number	:	1235275785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOROTA E PUCYK M.D.

Provider Business Mailing Address
First Line	:	5055 E BROADWAY BLVD
Second Line	:	A-100
City	:	TUCSON
State	:	AZ
Zip	:	85711-3640
Country	:	US
Telephone Number	:	520-327-0460
Fax Number	:	520-795-0225

Provider Business Practice Location Address
First Line	:	8710 N THORNYDALE RD STE 160
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-5037
Country	:	US
Telephone Number	:	520-744-2900
Fax Number	:	520-744-3318

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	02/08/2024

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