Provider Demographics
NPI:1215047196
Name:HADIKIN, WALTER RICHARD (MD)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:RICHARD
Last Name:HADIKIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18416 N CAVE CREEK RD
Mailing Address - Street 2:APT 3005
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-1035
Mailing Address - Country:US
Mailing Address - Phone:623-815-2900
Mailing Address - Fax:623-583-1319
Practice Address - Street 1:14973 W BELL RD
Practice Address - Street 2:STE #100
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3202
Practice Address - Country:US
Practice Address - Phone:623-815-2900
Practice Address - Fax:623-583-1319
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ34820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ984957Medicaid
AZ984957Medicaid
AZI26983Medicare UPIN