Provider Demographics
NPI:1548380603
Name:GARY WASLEWSKI MD PC
Entity type:Organization
Organization Name:GARY WASLEWSKI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WASLEWSKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:480-558-3744
Mailing Address - Street 1:11445 E. VIA LINDA ST #2
Mailing Address - Street 2:PMB 429
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2654
Mailing Address - Country:US
Mailing Address - Phone:480-558-3744
Mailing Address - Fax:480-558-3801
Practice Address - Street 1:5111 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-7075
Practice Address - Country:US
Practice Address - Phone:480-558-3744
Practice Address - Fax:480-558-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27254207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG82900Medicare UPIN