MEDICARE: ALEXANDER PIATKA PH.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	103TC0700X	Clinical Psychologist	2089	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	:	1447228721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER PIATKA PH.D.

Provider Business Mailing Address
First Line	:	1010 N COUNTRY CLUB DR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-3309
Country	:	US
Telephone Number	:	480-461-2409
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 E WILLETTA ST
Second Line	:	3RD & 5TH FLOOR
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2749
Country	:	US
Telephone Number	:	602-239-2361
Fax Number	:

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	07/05/2011

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