Healthcare Provider Details

I. General information

NPI: 1588375596
Provider Name (Legal Business Name): ZACHARY MIGLIORE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 N 2ND ST STE 401
PHOENIX AZ
85012-2371
US

IV. Provider business mailing address

2700 N HAYDEN RD APT 2076
SCOTTSDALE AZ
85257-1762
US

V. Phone/Fax

Practice location:
  • Phone: 602-606-8949
  • Fax: 602-759-7409
Mailing address:
  • Phone: 708-715-9706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9974
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: