Provider Demographics
NPI:1508042334
Name:MICHIELI, GIOVANI IVAN (MD)
Entity Type:Individual
Prefix:
First Name:GIOVANI
Middle Name:IVAN
Last Name:MICHIELI
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 1:2201 E CAMELBACK RD STE 101A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3495
Mailing Address - Country:US
Mailing Address - Phone:602-218-4075
Mailing Address - Fax:602-218-4076
Practice Address - Street 1:2201 E CAMELBACK RD STE 101A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3495
Practice Address - Country:US
Practice Address - Phone:602-218-4075
Practice Address - Fax:602-218-4076
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42022207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ22506OtherMEDICARE GROUP PIN
AZ470686Medicaid
AZZ189269Medicare PIN
AZZ148314Medicare PIN