Provider Demographics
NPI:1104024785
Name:MICHAEL A AMADEI M.D PC
Entity Type:Organization
Organization Name:MICHAEL A AMADEI M.D PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMADEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-204-4900
Mailing Address - Street 1:PO BOX 4176
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-2615
Mailing Address - Country:US
Mailing Address - Phone:928-204-4900
Mailing Address - Fax:928-204-4917
Practice Address - Street 1:3700 W HIGHWAY 89A
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-4937
Practice Address - Country:US
Practice Address - Phone:928-204-4900
Practice Address - Fax:928-204-4917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ251033OtherAHCCCS ID
AZ03D0956489OtherCLIA LAB ID
AZ03D0956489OtherCLIA LAB ID
AZAA2470540OtherDEA
AZC99052Medicare UPIN