Provider Demographics
NPI:1780815076
Name:STURM, MICHAEL CHRISTIAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHRISTIAN
Last Name:STURM
Suffix:
Gender:M
Credentials:OD
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 368
Mailing Address - Street 2:ATTN: EYE CLINIC
Mailing Address - City:KAYENTA
Mailing Address - State:AZ
Mailing Address - Zip Code:86033-0368
Mailing Address - Country:US
Mailing Address - Phone:928-697-4161
Mailing Address - Fax:928-697-4163
Practice Address - Street 1:KAYENTA HEALTH CENTER, HIGHWAY 163
Practice Address - Street 2:BUILDING KA-2010
Practice Address - City:KAYENTA
Practice Address - State:AZ
Practice Address - Zip Code:86033
Practice Address - Country:US
Practice Address - Phone:928-697-4161
Practice Address - Fax:928-697-4163
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2740152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ060012Medicaid
AZHSZ045Medicare PIN
AZ030073Medicare Oscar/Certification