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Organization

SOLSTICE PEDIATRICS AND SPORTS MEDICINE, PLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICHAEL JOSEPH PUCHOWICZ MD (AUTHORIZED MEMBER)
(203) 913-7092
Entity
Organization

Contact information

Practice address
4731 S WHITE MOUNTAIN RD, SHOW LOW, AZ 85901-7818
(203) 913-7092
Mailing address
2702 E SYLVIA ST, TUCSON, AZ 85716-2181
(203) 913-7092

Taxonomy

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

Other

Enumeration date
09/06/2011
Last updated
09/06/2011
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