Provider Demographics
NPI:1982605143
Name:KATES, MICHAEL J (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:KATES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 W BETHANY HOME RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-1919
Mailing Address - Country:US
Mailing Address - Phone:602-973-3888
Mailing Address - Fax:602-973-3028
Practice Address - Street 1:3401 W BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-1919
Practice Address - Country:US
Practice Address - Phone:602-973-3888
Practice Address - Fax:602-973-3028
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0080213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0065410OtherBCBS
AZ1Z1181OtherHEALTH NET
AZT41804Medicare UPIN
AZ4961410001Medicare NSC
AZAZ0065410OtherBCBS