Provider Demographics
NPI:1043286024
Name:RYCHETSKY, LENKA (MD)
Entity type:Individual
Prefix:
First Name:LENKA
Middle Name:
Last Name:RYCHETSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 E BROADWAY BLVD
Mailing Address - Street 2:A-100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3640
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:7440 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2306
Practice Address - Country:US
Practice Address - Phone:520-367-5620
Practice Address - Fax:520-367-5955
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28782207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ553976Medicaid
AZ553976Medicaid
AZ553976Medicaid