Provider Demographics
NPI:1134786510
Name:L.M. DEMIDOWICH PLLC
Entity type:Organization
Organization Name:L.M. DEMIDOWICH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DEMIDOWICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-464-7742
Mailing Address - Street 1:PO BOX 27077
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86312-7077
Mailing Address - Country:US
Mailing Address - Phone:973-464-7742
Mailing Address - Fax:
Practice Address - Street 1:2286 CROSSWIND DR STE C
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-6100
Practice Address - Country:US
Practice Address - Phone:973-464-7742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty