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NPI Code Detail

MEDICARE: DR. MICHELE ANN PRESTON D.O

MEDICARE: DR. MICHELE ANN PRESTON 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
1207P00000XEmergency Medicine Physician3877AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760432793
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHELE ANN PRESTON D.O
Provider Business Mailing Address
First Line : 1076 PRESTWICK DR
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86406-7839
Country : US
Telephone Number : 928-208-8440
Fax Number :
Provider Business Practice Location Address
First Line : 101 CIVIC CENTER LN
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86403-5607
Country : US
Telephone Number : 928-453-0174
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 12/23/2016

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