MEDICARE: PAX PEDIACTRICS PLLC

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	208000000X	Pediatrics Physician	17503	AZ

General Provider Information

NPI Number	:	1952652893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAX PEDIACTRICS PLLC

Provider Business Mailing Address
First Line	:	3933 E EDNA AVE
Second Line	:	SUITE 102
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3933 E EDNA AVE
Second Line	:	SUITE 102
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2127
Country	:	US
Telephone Number	:	602-569-5437
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. DONNI FLEISCHAKER
Credential	:	M.D.
Telephone Number	:	602-569-5437

Provider Enumeration Date	:	10/01/2012
Last Update Date	:	10/01/2012

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