MEDICARE: MICHELLE R HITCHCOCK PA-C

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	363AS0400X	Surgical Physician Assistant	3006	AZ
2	363A00000X	Physician Assistant	3006	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3Z3936	OTHER	AZ	HEALTHNET
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467492637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE R HITCHCOCK PA-C

Provider Business Mailing Address
First Line	:	13203 N 103RD AVE STE H5
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3032
Country	:	US
Telephone Number	:	623-777-4747
Fax Number	:

Provider Business Practice Location Address
First Line	:	13203 N 103RD AVE STE H5
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3032
Country	:	US
Telephone Number	:	623-777-4747
Fax Number	:

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	03/25/2025

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