Provider Demographics
NPI:1346330412
Name:MICHAEL, SULTAN GHILA (MD)
Entity Type:Individual
Prefix:
First Name:SULTAN
Middle Name:GHILA
Last Name:MICHAEL
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 1:2140 W 24TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6122
Mailing Address - Country:US
Mailing Address - Phone:928-341-4885
Mailing Address - Fax:928-782-1686
Practice Address - Street 1:3115 S PRICE RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-3544
Practice Address - Country:US
Practice Address - Phone:888-488-7640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32987207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00255649OtherRAILROAD MEDICARE
AZAZ0774360OtherBCBS
AZ868896Medicaid
AZ103389Medicare ID - Type UnspecifiedMEDICARE
AZ868896Medicaid