Provider Demographics
NPI:1891825022
Name:DOROZ, MICHELLE (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:DOROZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 S MERRYVALE LN
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-6567
Mailing Address - Country:US
Mailing Address - Phone:928-527-4325
Mailing Address - Fax:928-527-4327
Practice Address - Street 1:1501 S YALE ST
Practice Address - Street 2:BLDG 2 SUITE 150
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-7304
Practice Address - Country:US
Practice Address - Phone:928-527-4325
Practice Address - Fax:928-527-4327
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4045207Q00000X
CODR-50509208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46408371Medicaid
CO1902162753OtherBCBS
AZ881038Medicaid
AZZ144096Medicare PIN
COCOA107414Medicare PIN
AZZ79762Medicare PIN
AZ881038Medicaid
AZZ144095Medicare PIN
CO46408371Medicaid
AZZ147919Medicare PIN