Provider Demographics
NPI:1982743282
Name:HORN, MICHAEL JAMES (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:HORN
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 1:5055 VAN SICKLE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3829
Mailing Address - Country:US
Mailing Address - Phone:928-863-0713
Mailing Address - Fax:928-773-0507
Practice Address - Street 1:5055 VAN SICKLE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3829
Practice Address - Country:US
Practice Address - Phone:928-863-0713
Practice Address - Fax:928-773-0507
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26885207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ24545Medicare ID - Type Unspecified
AZC51010Medicare UPIN