Provider Demographics
NPI:1033247630
Name:LOES, MICHAEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:LOES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7402 E WETHERSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-4719
Mailing Address - Country:US
Mailing Address - Phone:480-250-1438
Mailing Address - Fax:602-331-2499
Practice Address - Street 1:11047 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4816
Practice Address - Country:US
Practice Address - Phone:602-944-2222
Practice Address - Fax:602-331-2499
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMD11336207RA0401X
AZ11336207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0397010OtherBLUE CROSS BLUE SHIELD
AZ188372200OtherOWCP FEDERAL COMPENSATION
AZ25492002OtherAHCCCS
AZC99885Medicare UPIN