Provider Demographics
NPI:1528164555
Name:UHRIK PC
Entity type:Organization
Organization Name:UHRIK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:
Authorized Official - Last Name:UHRIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-214-8800
Mailing Address - Street 1:PMB 108 STE B8
Mailing Address - Street 2:1022
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4654
Mailing Address - Country:US
Mailing Address - Phone:602-548-2200
Mailing Address - Fax:602-548-3013
Practice Address - Street 1:10228 W COGGINS DR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3421
Practice Address - Country:US
Practice Address - Phone:623-214-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29559208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ69171Medicare PIN