Healthcare Provider Details

I. General information

NPI: 1013990563
Provider Name (Legal Business Name): TICH-HAO MACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6114 N 59TH AVE STE 4
GLENDALE AZ
85301-7769
US

IV. Provider business mailing address

6114 N 59TH AVE STE 4
GLENDALE AZ
85301-7769
US

V. Phone/Fax

Practice location:
  • Phone: 623-937-8643
  • Fax:
Mailing address:
  • Phone: 623-937-8643
  • Fax: 623-934-1249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16640
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16640
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: