Healthcare Provider Details

I. General information

NPI: 1902941438
Provider Name (Legal Business Name): MICHELLE M SINDORF II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 W GLENN DR
GLENDALE AZ
85301-2628
US

IV. Provider business mailing address

5430 W GLENN DR
GLENDALE AZ
85301-2628
US

V. Phone/Fax

Practice location:
  • Phone: 623-915-0345
  • Fax: 623-937-5425
Mailing address:
  • Phone: 623-915-0345
  • Fax: 623-937-5425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number3267
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: