Provider Demographics
NPI:1376756379
Name:MICHAEL J. FUCCI MD, PC
Entity Type:Organization
Organization Name:MICHAEL J. FUCCI MD, PC
Other - Org Name:ARIZONA HEARING AND BALANCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:K
Authorized Official - Last Name:AMBLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-558-5306
Mailing Address - Street 1:225 S. DOBSON RD.
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224
Mailing Address - Country:US
Mailing Address - Phone:480-558-5306
Mailing Address - Fax:480-558-5307
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26456305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ520660Medicaid
AZE72904Medicare UPIN
AZ520660Medicaid