Healthcare Provider Details

I. General information

NPI: 1255650073
Provider Name (Legal Business Name): JASON D MICHAELS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14275 N 87TH ST STE 110
SCOTTSDALE AZ
85260-3696
US

IV. Provider business mailing address

3800 PARK NICOLLET BLVD DERMATOLOGY DEPARTMENT - 4TH FLOOR
ST LOUIS PARK MN
55416-2527
US

V. Phone/Fax

Practice location:
  • Phone: 480-905-7274
  • Fax: 480-905-7274
Mailing address:
  • Phone: 952-993-3123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number57833
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number44434
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: