Provider Demographics
NPI:1427026491
Name:O'MEARA, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:O'MEARA
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 1:6402 E SUPERSTITION SPRINGS BLVD
Mailing Address - Street 2:224
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4392
Mailing Address - Country:US
Mailing Address - Phone:480-835-6100
Mailing Address - Fax:480-461-4261
Practice Address - Street 1:6750 E BAYWOOD AVE
Practice Address - Street 2:301
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1749
Practice Address - Country:US
Practice Address - Phone:480-835-6100
Practice Address - Fax:480-461-4261
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14658207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0600005005OtherRAIL ROAD MEDICARE
AZ240614Medicaid
AZ0600005005OtherRAIL ROAD MEDICARE
AZZ148439Medicare PIN
AZZ06WCHKR03Medicare PIN
AZD00066Medicare UPIN