Healthcare Provider Details

I. General information

NPI: 1437174208
Provider Name (Legal Business Name): RACHAEL MARIE STILLWAGON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHAEL MARIE CARMICHAEL P.A.

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 N 92ND ST STE 130
SCOTTSDALE AZ
85258-4535
US

IV. Provider business mailing address

7514 E MONTEREY WAY STE 1
SCOTTSDALE AZ
85251-6900
US

V. Phone/Fax

Practice location:
  • Phone: 480-614-8011
  • Fax: 480-614-8014
Mailing address:
  • Phone: 804-949-7377
  • Fax: 480-949-8339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number2626
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: