Healthcare Provider Details

I. General information

NPI: 1447780374
Provider Name (Legal Business Name): MICHAEL HENRY VIEIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 N STOCKTON HILL RD STE 100
KINGMAN AZ
86401-4622
US

IV. Provider business mailing address

3269 N STOCKTON HILL RD
KINGMAN AZ
86409-3619
US

V. Phone/Fax

Practice location:
  • Phone: 928-681-8706
  • Fax: 928-681-8707
Mailing address:
  • Phone: 928-263-4722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number62387
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: