Healthcare Provider Details

I. General information

NPI: 1679538441
Provider Name (Legal Business Name): ARIZONA OTOLARYNGOLOGY CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 E SHEA BLVD STE 180
PHOENIX AZ
85028-6042
US

IV. Provider business mailing address

4530 E SHEA BLVD STE 180
PHOENIX AZ
85028-6042
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-4834
  • Fax: 602-254-5178
Mailing address:
  • Phone: 602-264-4834
  • Fax: 602-254-5178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateAZ

VIII. Authorized Official

Name: DR. JOHN M MILLIGAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 602-264-4834