Provider Demographics
NPI:1740256361
Name:FERMO, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:FERMO
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:PO BOX 5655
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85312-5655
Mailing Address - Country:US
Mailing Address - Phone:480-235-5579
Mailing Address - Fax:602-368-1140
Practice Address - Street 1:2545W QUAIL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2418
Practice Address - Country:US
Practice Address - Phone:480-235-5579
Practice Address - Fax:602-368-1140
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2015-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ283172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ76245Medicare UPIN
AZ76246Medicare ID - Type Unspecified