Individual
MR. MICHAEL JAMES SIVAK III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
16100 E PALISADES BLVD, FOUNTAIN HILLS, AZ 85268
(480) 664-5500
Mailing address
2320 W COLUMBINE DRIVE, PHOENIX, AZ 85029
(954) 649-6340
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP049466
AZ
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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