Provider Demographics
NPI:1104037449
Name:MICHAEL AMOA ASARE
Entity Type:Organization
Organization Name:MICHAEL AMOA ASARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AMOA-ASARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-678-1620
Mailing Address - Street 1:2618 E DESERT BROOM PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-2463
Mailing Address - Country:US
Mailing Address - Phone:480-203-4028
Mailing Address - Fax:480-821-9555
Practice Address - Street 1:485 S DODSON ROAD
Practice Address - Street 2:STE 105
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-2463
Practice Address - Country:US
Practice Address - Phone:480-203-4028
Practice Address - Fax:480-821-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31244208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ77658Medicaid
AZ77658Medicaid
AZH99250Medicare UPIN