Provider Demographics
NPI:1972506616
Name:HALE, MICAH D (DO)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:D
Last Name:HALE
Suffix:
Gender:M
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:PO BOX 27646
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-0144
Mailing Address - Country:US
Mailing Address - Phone:831-818-9833
Mailing Address - Fax:
Practice Address - Street 1:1390 MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-5404
Practice Address - Country:US
Practice Address - Phone:877-834-0008
Practice Address - Fax:415-558-1764
Is Sole Proprietor?:No
Enumeration Date:2005-05-25
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8534207P00000X, 207Q00000X
AZ005389207PE0004X
AZ5389207QA0401X, 2083A0300X
CA20A-85342083A0300X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1972506616Medicaid
CA020A85340Medicare PIN
AZH61694Medicare UPIN
CA1972506616Medicaid
CA020A85343Medicare PIN
CA020A85344Medicare PIN
CAH61694Medicare UPIN
CABU619ZMedicare PIN