Basic Information
| Provider Information | |||||||||
| NPI: | 1952414401 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIEKUT | ||||||||
| FirstName: | DOROTHY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10618 E BUTHERUS DR | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852558583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805133134 | ||||||||
| FaxNumber: | 4805133135 | ||||||||
| Practice Location | |||||||||
| Address1: | 10550 W MCDOWELL RD | ||||||||
| Address2: | |||||||||
| City: | AVONDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853924864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803455400 | ||||||||
| FaxNumber: | 4803455450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 07/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 27151 | AZ | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 27151 | 01 | AZ | LICENCE | OTHER |