Provider Demographics
NPI:1285713636
Name:OPECHOWSKI, THOMAS A (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:OPECHOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 N. POWER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215
Mailing Address - Country:US
Mailing Address - Phone:480-827-6878
Mailing Address - Fax:360-566-6778
Practice Address - Street 1:2929 N. POWER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215
Practice Address - Country:US
Practice Address - Phone:480-827-6878
Practice Address - Fax:360-566-6778
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ226762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ22676OtherLICENSE
AZ312059Medicaid
ZMD22676Medicare ID - Type Unspecified
G01615Medicare UPIN