Healthcare Provider Details

I. General information

NPI: 1174868855
Provider Name (Legal Business Name): MICHAEL IYAMU D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14775 W YORKSHIRE DR
SURPRISE AZ
85374-7224
US

IV. Provider business mailing address

3317 S HIGLEY RD STE 114
GILBERT AZ
85297-5437
US

V. Phone/Fax

Practice location:
  • Phone: 623-594-5050
  • Fax:
Mailing address:
  • Phone: 602-587-7186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number006982
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: