Provider Demographics
NPI:1578286050
Name:LE, MICHAEL HAI ANH (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HAI ANH
Last Name:LE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16515 S 40TH ST STE 143
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0560
Mailing Address - Country:US
Mailing Address - Phone:480-712-8319
Mailing Address - Fax:480-712-1305
Practice Address - Street 1:16515 S 40TH ST STE 143
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0560
Practice Address - Country:US
Practice Address - Phone:480-712-8319
Practice Address - Fax:480-712-1305
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant