Provider Demographics
NPI:1871548719
Name:DEKUTOSKI, SHAUN E (MD)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:E
Last Name:DEKUTOSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:623-434-6200
Mailing Address - Fax:623-434-6164
Practice Address - Street 1:6677 W THUNDERBIRD RD
Practice Address - Street 2:STE. A124
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3709
Practice Address - Country:US
Practice Address - Phone:623-773-2266
Practice Address - Fax:623-773-2267
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2013-09-06
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Provider Licenses
StateLicense IDTaxonomies
MN34578207Q00000X
AZ48062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine