Provider Demographics
NPI:1063409449
Name:SEKOSKY, MICHAEL J (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:SEKOSKY
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 1:11046 N SAGUARO BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-5537
Mailing Address - Country:US
Mailing Address - Phone:480-837-2240
Mailing Address - Fax:480-836-8566
Practice Address - Street 1:11046 N SAGUARO BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-5537
Practice Address - Country:US
Practice Address - Phone:480-837-2240
Practice Address - Fax:480-836-8566
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0320213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0190570OtherBLUE CROSS BLUE SHIELD
AZAZ1830OtherHEALTH NET
AZ19496603Medicaid
AZZDPM320Medicare PIN
AZAZ1830OtherHEALTH NET
AZ19496603Medicaid
Z120947Medicare PIN