Provider Demographics
NPI:1134280738
Name:MICHAEL J. FLORES MD PC
Entity Type:Organization
Organization Name:MICHAEL J. FLORES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-774-3318
Mailing Address - Street 1:1100 N SAN FRANCISCO ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3260
Mailing Address - Country:US
Mailing Address - Phone:928-774-3318
Mailing Address - Fax:928-774-3847
Practice Address - Street 1:1100 N SAN FRANCISCO ST
Practice Address - Street 2:SUITE E
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3260
Practice Address - Country:US
Practice Address - Phone:928-774-3318
Practice Address - Fax:928-774-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15978305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ281462Medicaid
AZDG5546OtherRAILROAD MEDICARE GROUP
AZD36845Medicare UPIN
AZ281462Medicaid