Provider Demographics
NPI:1134299662
Name:MICHAEL J MCCAULEY MD PC
Entity Type:Organization
Organization Name:MICHAEL J MCCAULEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-413-0065
Mailing Address - Street 1:1950 S COUNTRY CLUB DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6044
Mailing Address - Country:US
Mailing Address - Phone:480-413-0065
Mailing Address - Fax:480-413-0069
Practice Address - Street 1:1950 S COUNTRY CLUB DR STE 102
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6044
Practice Address - Country:US
Practice Address - Phone:480-413-0065
Practice Address - Fax:480-413-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ896201Medicaid
AZ6258200001OtherMEDICARE DME PTAN
AZ6258200001OtherMEDICARE DME PTAN