Provider Demographics
NPI:1174510556
Name:FUCCI, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:FUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9097 E DESERT COVE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6280
Mailing Address - Country:US
Mailing Address - Phone:480-273-8510
Mailing Address - Fax:480-214-9933
Practice Address - Street 1:225 S. DOBSON RD.
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-558-5306
Practice Address - Fax:480-558-5307
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2020-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ26456207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1089172010OtherCIGNA NUMBER
AZ520660OtherAHCCCS
AZ1Z0832OtherHEALTHNET NUMBER
AZ1000104OtherUNITED HEALTH CARE NUMBER
AZ4292122OtherAETNA NUMBER
AZAZ0876560OtherBCBS NUMBER
AZ1089172010OtherCIGNA NUMBER
AZZ62980Medicare ID - Type UnspecifiedMEDICARE ID