Healthcare Provider Details

I. General information

NPI: 1174510556
Provider Name (Legal Business Name): MICHAEL J. FUCCI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S. DOBSON RD.
CHANDLER AZ
85224
US

IV. Provider business mailing address

9097 E DESERT COVE AVE STE 200
SCOTTSDALE AZ
85260-6280
US

V. Phone/Fax

Practice location:
  • Phone: 480-558-5306
  • Fax: 480-558-5307
Mailing address:
  • Phone: 480-273-8510
  • Fax: 480-214-9933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number26456
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: