Healthcare Provider Details

I. General information

NPI: 1023882420
Provider Name (Legal Business Name): MICHELLE SCHICK RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 N 31ST AVE STE C105
PHOENIX AZ
85051-9625
US

IV. Provider business mailing address

18001 N 79TH AVE STE A12
GLENDALE AZ
85308-8398
US

V. Phone/Fax

Practice location:
  • Phone: 623-399-6825
  • Fax: 623-505-3474
Mailing address:
  • Phone: 623-399-6825
  • Fax: 623-505-3474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86117614
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: