MEDICARE: GARY WASLEWSKI MD PC

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	27254	AZ

General Provider Information

NPI Number	:	1548380603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY WASLEWSKI MD PC

Provider Business Mailing Address
First Line	:	11445 E. VIA LINDA ST #2
Second Line	:	PMB 429
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85259-2654
Country	:	US
Telephone Number	:	480-558-3744
Fax Number	:	480-558-3801

Provider Business Practice Location Address
First Line	:	5111 N SCOTTSDALE RD
Second Line	:	SUITE 101
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85250-7075
Country	:	US
Telephone Number	:	480-558-3744
Fax Number	:	480-558-3801

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	DR. GARY WASLEWSKI JR.
Credential	:	MD
Telephone Number	:	480-558-3744

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	12/12/2008

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