MEDICARE: DR. MICHAEL A LAVOR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	20041	AZ
2	208600000X	Surgery Physician	20041	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	69472	OTHER	AZ	PACIFICARE
2	2Z3171	OTHER	AZ	HEALTH NET
3	O55823-22	OTHER	AZ	AHCCCS
4	AZ0153300	OTHER	AZ	BCBS
5	203604285	OTHER	AZ	UNITED

General Provider Information

NPI Number	:	1063440972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL A LAVOR MD

Provider Business Mailing Address
First Line	:	3650 N CAMINO OJO DE AGUA
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85749-7811
Country	:	US
Telephone Number	:	520-440-3004
Fax Number	:

Provider Business Practice Location Address
First Line	:	7140 E ROSEWOOD ST STE 110
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-1346
Country	:	US
Telephone Number	:	520-440-3004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	10/03/2023

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Directions to “ DR. MICHAEL A LAVOR MD” Practice Location

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