Healthcare Provider Details

I. General information

NPI: 1558414839
Provider Name (Legal Business Name): MICHELLE ELDON MADDEN FELICELLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE ELDON MADDEN M.D.

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W THOMAS RD
PHOENIX AZ
85013-4409
US

IV. Provider business mailing address

1255 W WASHINGTON ST
TEMPE AZ
85281-1210
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-9007
  • Fax:
Mailing address:
  • Phone: 602-685-5166
  • Fax: 602-685-5325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number54665
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number54665
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: