Provider Demographics
NPI:1124156997
Name:ROYKO, IRENE ANNA (MD)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:ANNA
Last Name:ROYKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:IRENE
Other - Middle Name:ANNA
Other - Last Name:MICHELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1654 COYOTE RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-5339
Mailing Address - Country:US
Mailing Address - Phone:928-778-4767
Mailing Address - Fax:928-778-4767
Practice Address - Street 1:1654 COYOTE RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-5339
Practice Address - Country:US
Practice Address - Phone:928-778-4767
Practice Address - Fax:928-778-4767
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZC35339Medicare UPIN
01WCGWM04Medicare ID - Type Unspecified