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Individual

MICHAEL JOSEPH PUCHOWICZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
4830 HIGHWAY 260, SUITE 102, LAKESIDE, AZ 85929-5845
(928) 537-1040
(928) 537-1042
Mailing address
4830 HIGHWAY 260, SUITE 102, LAKESIDE, AZ 85929-5845
(928) 537-1040
(928) 537-1042

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
44940
AZ
2080S0010X
Pediatric Sports Medicine Physician
Primary
44940
AZ

Other

Enumeration date
09/04/2009
Last updated
04/06/2012
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