Healthcare Provider Details

I. General information

NPI: 1851906515
Provider Name (Legal Business Name): TOTAL HEALTH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 01/12/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S DELAWARE DR STE 2
APACHE JUNCTION AZ
85120-6512
US

IV. Provider business mailing address

105 S DELAWARE DR STE 2
APACHE JUNCTION AZ
85120-6512
US

V. Phone/Fax

Practice location:
  • Phone: 602-777-7718
  • Fax:
Mailing address:
  • Phone: 480-228-8048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL IGWE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 480-228-8048