Provider Demographics
NPI:1740217512
Name:GORDON, MICHAEL H (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 N 32ND ST
Mailing Address - Street 2:175
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3956
Mailing Address - Country:US
Mailing Address - Phone:602-952-0002
Mailing Address - Fax:602-778-4565
Practice Address - Street 1:4444 N 32ND ST
Practice Address - Street 2:175
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3956
Practice Address - Country:US
Practice Address - Phone:602-952-0002
Practice Address - Fax:602-778-4565
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ14964207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBG0421292OtherDEA
AZBG0421292OtherDEA
AZWDBBM01Medicare ID - Type Unspecified