Provider Demographics
NPI:1083667521
Name:ADOBE E.N.T. & ALLERGY
Entity Type:Organization
Organization Name:ADOBE E.N.T. & ALLERGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-649-8150
Mailing Address - Street 1:116 N. LINDSAY RD.
Mailing Address - Street 2:STE #2
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213
Mailing Address - Country:US
Mailing Address - Phone:480-649-8150
Mailing Address - Fax:480-649-9905
Practice Address - Street 1:116 N. LINDSAY RD
Practice Address - Street 2:STE. #2
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213
Practice Address - Country:US
Practice Address - Phone:480-649-8150
Practice Address - Fax:480-649-9905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2767174400000X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WCKLF01Medicare PIN
AZE96461Medicare UPIN