Provider Demographics
NPI:1396701397
Name:DORSEY, MICHELLE LEE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LEE
Last Name:DORSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:LEE
Other - Last Name:SEIFERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3850 E HUBER ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-3912
Mailing Address - Country:US
Mailing Address - Phone:480-290-2036
Mailing Address - Fax:
Practice Address - Street 1:3850 E HUBER ST
Practice Address - Street 2:UNIT 1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-3912
Practice Address - Country:US
Practice Address - Phone:480-290-2036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ351822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00335761OtherRAILROAD MEDICARE
AZ089643Medicaid
AZP00335761OtherRAILROAD MEDICARE
I52927Medicare UPIN