Provider Demographics
NPI:1417117920
Name:MICHAEL AMOA ASARE LLC
Entity Type:Organization
Organization Name:MICHAEL AMOA ASARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AMOA-ASARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-689-6205
Mailing Address - Street 1:PO BOX 12238
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-0021
Mailing Address - Country:US
Mailing Address - Phone:480-525-0201
Mailing Address - Fax:
Practice Address - Street 1:485 S DOBSON RD STE 105
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5603
Practice Address - Country:US
Practice Address - Phone:480-525-0201
Practice Address - Fax:480-530-0750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31244207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ791550Medicaid
AZ791550Medicaid