Provider Demographics
NPI:1689420176
Name:CHAVKA, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:CHAVKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10609 N FRANK LLOYD WRIGHT BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2660
Mailing Address - Country:US
Mailing Address - Phone:480-572-0081
Mailing Address - Fax:
Practice Address - Street 1:10609 N FRANK LLOYD WRIGHT BLVD STE 120
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-2659
Practice Address - Country:US
Practice Address - Phone:480-572-0081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty