Healthcare Provider Details

I. General information

NPI: 1932264843
Provider Name (Legal Business Name): MICHAEL THOMAS AMMANN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 E LA CANADA, STE 135
GREEN VALLEY AZ
85614
US

IV. Provider business mailing address

5055 E BROADWAY BLVD STE A100
TUCSON AZ
85711
US

V. Phone/Fax

Practice location:
  • Phone: 520-625-3230
  • Fax: 520-625-9162
Mailing address:
  • Phone: 520-382-1205
  • Fax: 520-795-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2536
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: