Healthcare Provider Details

I. General information

NPI: 1386900652
Provider Name (Legal Business Name): MICHAEL ROBERT CONTI MICA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 N 90TH PL
SCOTTSDALE AZ
85258-5067
US

IV. Provider business mailing address

9735 N 90TH PL
SCOTTSDALE AZ
85258-5067
US

V. Phone/Fax

Practice location:
  • Phone: 602-953-9500
  • Fax:
Mailing address:
  • Phone: 602-953-9500
  • Fax: 480-210-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036147079
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2017-00214
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number036147079
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number66890
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: