Provider Demographics
NPI:1013990563
Name:MACH, TICH-HAO (MD)
Entity Type:Individual
Prefix:DR
First Name:TICH-HAO
Middle Name:
Last Name:MACH
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 1:6114 N 59TH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-7769
Mailing Address - Country:US
Mailing Address - Phone:623-937-8643
Mailing Address - Fax:623-934-1249
Practice Address - Street 1:6114 N 59TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-7769
Practice Address - Country:US
Practice Address - Phone:623-937-8643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16640208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ267717Medicaid
AZ267717Medicaid