1427111426 NPI number — MICHELLE MARIE MCCLOSKEY MED

Table of content: MICHELLE MARIE MCCLOSKEY MED (NPI 1427111426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427111426 NPI number — MICHELLE MARIE MCCLOSKEY MED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLOSKEY
Provider First Name:
MICHELLE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRUNO
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427111426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3623 E GOLDFINCH GATE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85044-4517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-488-1294
Provider Business Mailing Address Fax Number:
480-704-2657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3623 E GOLDFINCH GATE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85044-4517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-488-1294
Provider Business Practice Location Address Fax Number:
480-704-2657
Provider Enumeration Date:
12/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)