MEDICARE: MARVIN T RACOWSKY PA

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	363A00000X	Physician Assistant	1229	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	67566	OTHER	AZ	MEDICARE PIN #

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	:	1871567461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARVIN T RACOWSKY PA

Provider Business Mailing Address
First Line	:	PO BOX 32950
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85064-2950
Country	:	US
Telephone Number	:	602-433-1822
Fax Number	:	602-246-7060

Provider Business Practice Location Address
First Line	:	8260 W INDIAN SCHOOL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85033
Country	:	US
Telephone Number	:	632-846-7122
Fax Number	:	623-846-7027

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	07/08/2007

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Directions to “ MARVIN T RACOWSKY PA” Practice Location

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