Provider Demographics
NPI:1760479919
Name:EMBLING, MICHELLE L (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:EMBLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8024 E MERCER LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6562
Mailing Address - Country:US
Mailing Address - Phone:205-910-5720
Mailing Address - Fax:
Practice Address - Street 1:8024 E MERCER LN
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6562
Practice Address - Country:US
Practice Address - Phone:205-910-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.18514207P00000X, 208000000X
AZ44863207P00000X, 208000000X, 207PP0204X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-95529OtherBCBS
AL515-43725OtherBCBS
AZ146198Medicaid
AL102672Medicaid
AL009928310Medicaid
AL5864412OtherAETNA
AL1760479919OtherTRICARE SOUTH
AL510-95529OtherBCBS