Provider Demographics
NPI:1740386945
Name:MEDCHILL, MICHAEL TOM (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TOM
Last Name:MEDCHILL
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:PO BOX 51180
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85076-1180
Mailing Address - Country:US
Mailing Address - Phone:602-264-1771
Mailing Address - Fax:602-264-1661
Practice Address - Street 1:500 W THOMAS RD
Practice Address - Street 2:STE 730
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4224
Practice Address - Country:US
Practice Address - Phone:602-264-1771
Practice Address - Fax:602-264-1661
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20807174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ115156Medicaid
AZE44002Medicare UPIN