Healthcare Provider Details

I. General information

NPI: 1205681301
Provider Name (Legal Business Name): MICHAEL PATRICK WURZER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13657 W MCDOWELL RD STE 220
GOODYEAR AZ
85395-2603
US

IV. Provider business mailing address

6001 MOON ST NE APT 114
ALBUQUERQUE NM
87111-1449
US

V. Phone/Fax

Practice location:
  • Phone: 623-848-5609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: