Provider Demographics
NPI:1962621292
Name:CERCEK, ROBERT MICHAEL JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:CERCEK
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18444 N 25TH AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1266
Mailing Address - Country:US
Mailing Address - Phone:623-537-5600
Mailing Address - Fax:866-939-2673
Practice Address - Street 1:9321 W THOMAS RD STE 205
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3392
Practice Address - Country:US
Practice Address - Phone:866-974-2673
Practice Address - Fax:866-939-2673
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41492207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5550830004OtherMEDICARE NSC PV
AZ5550830006OtherMEDICARE NSC ANTHEM
AZ426753Medicaid
AZ5550830009OtherMEDICARE NSC AZ NORTH
AZ5550830007OtherMEDICARE NSC DV
AZ5550830001OtherMEDICARE NSC SCW
AZ5550830003OtherMEDICARE NSC PEORIA
AZ5550830010OtherMEDICARE NSC GILBERT
AZ5550830008OtherMEDICARE NSC SWV
AZ5550830007OtherMEDICARE NSC DV