Provider Demographics
NPI:1952520058
Name:SWEETEN, MICHAEL D (PAC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:SWEETEN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5946 W KESLER LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-4488
Mailing Address - Country:US
Mailing Address - Phone:480-363-3987
Mailing Address - Fax:
Practice Address - Street 1:4530 E MUIRWOOD DR STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7693
Practice Address - Country:US
Practice Address - Phone:480-763-5808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2901363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1059873OtherNATIONAL CERTIFICATION
AZ2901OtherSTATE LICENSE
AZMS1056147OtherDEA NUMBER