MEDICARE: DR. JAMES MICHAEL UNDERWOOD D.O.

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	208000000X	Pediatrics Physician	OH34007098	OH
2	208000000X	Pediatrics Physician	007525	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000354015	OTHER	OH	BLUE CROSS BLUE SHIELD PI

General Provider Information

NPI Number	:	1558365957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES MICHAEL UNDERWOOD D.O.

Provider Business Mailing Address
First Line	:	PO BOX 10097
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85130-0020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	44572 W BOWLIN RD
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138
Country	:	US
Telephone Number	:	520-568-2316
Fax Number	:	520-568-2316

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	05/30/2018

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