Healthcare Provider Details

I. General information

NPI: 1992820559
Provider Name (Legal Business Name): MICRODOSE INTERNATIONAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W APACHE TRL SUITE 710
APACHE JUNCTION AZ
85220-3942
US

IV. Provider business mailing address

6641 E. BAYWOOD AVE STE. C-2
MESA AZ
85206-1723
US

V. Phone/Fax

Practice location:
  • Phone: 480-983-8376
  • Fax: 480-671-5860
Mailing address:
  • Phone: 480-983-8376
  • Fax: 480-671-5860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VIRGIL I STENBERG
Title or Position: CHAIRMAN OF THE BOARD DIRECTORS
Credential: PH.D
Phone: 480-983-8376