Provider Demographics
NPI:1336458645
Name:MCMICHAN, JOHN C (MBBS, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:MCMICHAN
Suffix:
Gender:M
Credentials:MBBS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10661 E SAN SALVADOR DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-6117
Mailing Address - Country:US
Mailing Address - Phone:480-860-1012
Mailing Address - Fax:
Practice Address - Street 1:10661 E SAN SALVADOR DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-6117
Practice Address - Country:US
Practice Address - Phone:480-860-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZB11340996207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology