Provider Demographics
NPI:1053361568
Name:CHARSKI, JOHN ANTHONY (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:CHARSKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13990
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-3990
Mailing Address - Country:US
Mailing Address - Phone:480-614-1856
Mailing Address - Fax:480-614-5345
Practice Address - Street 1:9331 E HILLERY WAY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2857
Practice Address - Country:US
Practice Address - Phone:480-614-1856
Practice Address - Fax:480-614-5345
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDPM309213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ700973Medicaid
AZZ70621992AMedicare PIN
AZ700973Medicaid