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NPI Code Detail

MEDICARE: CHARLES A MICHIELI MD

MEDICARE: CHARLES A MICHIELI 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
1207Q00000XFamily Medicine Physician33407AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Z132754OTHERAZPTAN

General Provider Information

NPI Number : 1205892841
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES A MICHIELI MD
Provider Business Mailing Address
First Line : 5055 E. BROADWAY BLVD
Second Line : STE A-100
City : TUCSON
State : AZ
Zip : 85711
Country : US
Telephone Number : 520-327-0460
Fax Number : 520-795-0225
Provider Business Practice Location Address
First Line : 7105 N LA CHOLLA BLVD
Second Line :
City : TUCSON
State : AZ
Zip : 85741-3112
Country : US
Telephone Number : 520-547-0611
Fax Number : 520-547-0616
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2006
Last Update Date : 09/22/2021

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