Provider Demographics
NPI:1356440291
Name:WINER, MICHAEL H (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:WINER
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 1:7119 E SHEA BLVD
Mailing Address - Street 2:SUITE 109-528
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6107
Mailing Address - Country:US
Mailing Address - Phone:480-831-2225
Mailing Address - Fax:480-831-0535
Practice Address - Street 1:8124 E CACTUS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5262
Practice Address - Country:US
Practice Address - Phone:480-831-2225
Practice Address - Fax:480-831-0535
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ134883Medicaid
AZAZ0350900OtherBLUE CROSS NUMBER
AZAZ0342570OtherBLUE CROSS PROVIDER NUMBE
AZA10478Medicare UPIN
AZMD10104Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
AZ134883Medicaid