Provider Demographics
NPI:1558392415
Name:KASPARIAN, MICHELE (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:KASPARIAN
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 E MARYLAND AVE
Mailing Address - Street 2:#7
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-1456
Mailing Address - Country:US
Mailing Address - Phone:602-466-2482
Mailing Address - Fax:
Practice Address - Street 1:CARL T. HAYDEN VA MEDICAL CENTER
Practice Address - Street 2:650 E. INDIAN SCHOOL RD.
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2137363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical