Provider Demographics
NPI:1477561652
Name:DEMKO, MICHAEL JOHN (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:DEMKO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5252 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8022
Mailing Address - Country:US
Mailing Address - Phone:480-396-3222
Mailing Address - Fax:480-396-2298
Practice Address - Street 1:5252 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8022
Practice Address - Country:US
Practice Address - Phone:480-396-3222
Practice Address - Fax:480-396-2298
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2943207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ348260Medicaid
08WCHYW08Medicare PIN
AZ348260Medicaid