Provider Demographics
NPI:1043294606
Name:UNDERHILL, MICHAEL S (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:UNDERHILL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 E SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5499
Mailing Address - Country:US
Mailing Address - Phone:480-301-8000
Mailing Address - Fax:
Practice Address - Street 1:18275 N 59TH AVENUE
Practice Address - Street 2:BLDG K STE 162
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1254
Practice Address - Country:US
Practice Address - Phone:602-547-8184
Practice Address - Fax:602-547-8339
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3900207Q00000X, 207Q00000X
AZ70415160001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86080015085259D006OtherTRIWEST
AZ916637Medicaid
I25613Medicare UPIN
AZ916637Medicaid