Provider Demographics
NPI:1760449490
Name:VELDHUIZEN MICKEY, STACY DEANN (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:DEANN
Last Name:VELDHUIZEN MICKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:DEANN
Other - Last Name:VELDHUIZEN MICKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3815 E BELL RD STE 2200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2139
Mailing Address - Country:US
Mailing Address - Phone:602-633-3848
Mailing Address - Fax:602-633-3841
Practice Address - Street 1:7165 E UNIVERSITY DR STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-6400
Practice Address - Country:US
Practice Address - Phone:480-999-0049
Practice Address - Fax:866-918-8525
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2Z1949OtherHEALTHNET
AZ260027308OtherTAX ID
AZ0773670OtherBLUE CROSS BLUE SHIELD
AZ860783428OtherTAX ID
AZ834764001Medicaid
AZ260027308OtherTAX ID