Provider Demographics
NPI:1558357095
Name:MCCAULEY, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MCCAULEY
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 1:1950 S COUNTRY CLUB DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6044
Mailing Address - Country:US
Mailing Address - Phone:480-413-0065
Mailing Address - Fax:480-413-0069
Practice Address - Street 1:1950 S COUNTRY CLUB DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6043
Practice Address - Country:US
Practice Address - Phone:480-413-0065
Practice Address - Fax:480-413-0069
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13247174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ222448Medicaid
AZD44230Medicare UPIN
AZ222448Medicaid
AZ113423Medicare PIN