Organization
PROVIDENCE GENERAL MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERARDO SICALO OBORSKY M.D. (MEDICAL DIRECTOR)
(602) 254-7077
Entity
Organization
Contact information
Practice address
9220 N. CENTRAL AVENUE, PHOENIX, AZ 85020-2416
(602) 254-7077
(602) 254-7078
Mailing address
9220 N. CENTRAL AVENUE, PHOENIX, AZ 85020-2416
(602) 254-7077
(602) 254-7078
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
31836
AZ
Other
Enumeration date
03/19/2008
Last updated
09/27/2011
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