Provider Demographics
NPI:1316936297
Name:RINK, MARIE SLUKA (MD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:SLUKA
Last Name:RINK
Suffix:
Gender:F
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:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-838-8265
Mailing Address - Fax:702-804-3788
Practice Address - Street 1:20040 N 19TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4255
Practice Address - Country:US
Practice Address - Phone:623-869-5000
Practice Address - Fax:623-869-0927
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ470956Medicaid
AZZ197523Medicare PIN
AZ470956Medicaid
28171Medicare PIN