Basic Information
| Provider Information | |||||||||
| NPI: | 1871548719 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEKUTOSKI | ||||||||
| FirstName: | SHAUN | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 W UTOPIA RD | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850274171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6234346200 | ||||||||
| FaxNumber: | 6234346164 | ||||||||
| Practice Location | |||||||||
| Address1: | 6677 W THUNDERBIRD RD | ||||||||
| Address2: | STE. A124 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853063709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6237732266 | ||||||||
| FaxNumber: | 6237732267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 09/06/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34578 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 48062 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.