Provider Demographics
NPI:1497731327
Name:MEYER, MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 N FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-872-7265
Mailing Address - Fax:520-872-7963
Practice Address - Street 1:4511 N CAMPBELL AVE
Practice Address - Street 2:#100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6423
Practice Address - Country:US
Practice Address - Phone:520-529-4013
Practice Address - Fax:520-615-5409
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ422684Medicaid
AZ422684Medicaid
G66457Medicare UPIN