Provider Demographics
NPI:1912914870
Name:STEIN, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:STEIN
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 1:9502 N 46TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-5201
Mailing Address - Country:US
Mailing Address - Phone:623-977-5466
Mailing Address - Fax:623-875-8779
Practice Address - Street 1:7301 E 2ND ST STE 310
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5627
Practice Address - Country:US
Practice Address - Phone:480-970-1640
Practice Address - Fax:480-970-1641
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2017-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ115732086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZMD11573Medicare ID - Type Unspecified
AZD37698Medicare UPIN