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NPI Code Detail

MEDICARE: DR. FREDERICK J MENICK M.D.

MEDICARE: DR. FREDERICK J MENICK 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
1174400000XSpecialist11308AZ

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 : 1427042233
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FREDERICK J MENICK M.D.
Provider Business Mailing Address
First Line : 1102 N EL DORADO PL
Second Line :
City : TUCSON
State : AZ
Zip : 85715-4606
Country : US
Telephone Number : 520-881-4525
Fax Number : 520-881-2962
Provider Business Practice Location Address
First Line : 1102 N EL DORADO PL
Second Line :
City : TUCSON
State : AZ
Zip : 85715-4606
Country : US
Telephone Number : 520-881-4525
Fax Number : 520-881-2962
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2005
Last Update Date : 07/08/2007

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