Healthcare Provider Details

I. General information

NPI: 1962455782
Provider Name (Legal Business Name): MICHAEL K OFORI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CLARENDON AVE SUITE 142
PHOENIX AZ
85013-3449
US

IV. Provider business mailing address

PO BOX 36680
PHOENIX AZ
85067-6680
US

V. Phone/Fax

Practice location:
  • Phone: 602-234-1803
  • Fax: 602-234-3748
Mailing address:
  • Phone: 602-234-1803
  • Fax: 602-234-3748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25785
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: