Provider Demographics
NPI:1932264843
Name:AMMANN, MICHAEL THOMAS (DO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:AMMANN
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Gender:M
Credentials:DO
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Mailing Address - Street 1:5055 E BROADWAY BLVD
Mailing Address - Street 2:STE A100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711
Mailing Address - Country:US
Mailing Address - Phone:520-382-1205
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:1055 E LA CANADA, STE 135
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614
Practice Address - Country:US
Practice Address - Phone:520-625-3230
Practice Address - Fax:520-625-9162
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
AZ2536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ485767Medicaid
AZE44492Medicare UPIN