MEDICARE: DR. MICHELLE ELDON MADDEN FELICELLA M.D.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	54665	AZ
2	207ZN0500X	Neuropathology Physician	54665	AZ

General Provider Information

NPI Number	:	1558414839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE ELDON MADDEN FELICELLA M.D.

Provider Business Mailing Address
First Line	:	1255 W WASHINGTON ST
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85281-1210
Country	:	US
Telephone Number	:	602-685-5166
Fax Number	:	602-685-5325

Provider Business Practice Location Address
First Line	:	350 W THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-4409
Country	:	US
Telephone Number	:	602-263-9007
Fax Number	:

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	01/18/2018

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