MEDICARE: DR. MICHAEL DENICOLE DO

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	207QA0401X	Addiction Medicine (Family Medicine) Physician	2103	AZ

General Provider Information

NPI Number	:	1912166620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DENICOLE DO

Provider Business Mailing Address
First Line	:	2132 E NORTHVIEW AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-5661
Country	:	US
Telephone Number	:	602-615-8207
Fax Number	:

Provider Business Practice Location Address
First Line	:	2132 E NORTHVIEW AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-5661
Country	:	US
Telephone Number	:	602-615-8207
Fax Number	:

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

Provider Enumeration Date	:	06/06/2008
Last Update Date	:	06/06/2008

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