Healthcare Provider Details

I. General information

NPI: 1063494326
Provider Name (Legal Business Name): MICHAEL DIMLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 02/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E CAMBRIDGE AVE 201
PHOENIX AZ
85006-1459
US

IV. Provider business mailing address

1920 E CAMBRIDGE AVE 201
PHOENIX AZ
85006-1459
US

V. Phone/Fax

Practice location:
  • Phone: 602-254-5561
  • Fax: 602-254-2185
Mailing address:
  • Phone: 602-254-5561
  • Fax: 602-254-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number15831
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: