Provider Demographics
NPI:1114921467
Name:ROLLINS, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:ROLLINS
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 1:13555 W. MCDOWELL RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2626
Mailing Address - Country:US
Mailing Address - Phone:623-247-0300
Mailing Address - Fax:623-247-9268
Practice Address - Street 1:13555 W. MCDOWELL RD
Practice Address - Street 2:SUITE 204
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2626
Practice Address - Country:US
Practice Address - Phone:623-247-0300
Practice Address - Fax:623-247-9268
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30379208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ703745Medicaid
Z113202Medicare PIN
H73498Medicare UPIN
AZH73498Medicare UPIN
AZZ113202Medicare PIN