Provider Demographics
NPI:1063494326
Name:DIMLER, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:DIMLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 E CAMBRIDGE AVE
Mailing Address - Street 2:201
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-1459
Mailing Address - Country:US
Mailing Address - Phone:602-254-5561
Mailing Address - Fax:602-254-2185
Practice Address - Street 1:1920 E CAMBRIDGE AVE
Practice Address - Street 2:201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-1459
Practice Address - Country:US
Practice Address - Phone:602-254-5561
Practice Address - Fax:602-254-2185
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ158312086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ251546Medicaid
AZ251546Medicaid
AZB03416Medicare UPIN