Provider Demographics
NPI:1922013689
Name:MIGOTTO, WALTER HONORIO (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:HONORIO
Last Name:MIGOTTO
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 1:9145 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4820
Mailing Address - Country:US
Mailing Address - Phone:623-815-7800
Mailing Address - Fax:623-815-7900
Practice Address - Street 1:9171 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:623-815-7800
Practice Address - Fax:623-815-7900
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35416207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ127572Medicaid
AZ127572Medicaid
AZ110722Medicare PIN