Basic Information
| Provider Information | |||||||||
| NPI: | 1255517041 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALICZYNSKI | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2224 W NORTHERN AVE STE D300 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850215099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022771449 | ||||||||
| FaxNumber: | 6022779984 | ||||||||
| Practice Location | |||||||||
| Address1: | 2224 W NORTHERN AVE STE D300 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850215099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022771449 | ||||||||
| FaxNumber: | 6022779984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2008 | ||||||||
| LastUpdateDate: | 10/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 58002617 | OH | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.