Healthcare Provider Details

I. General information

NPI: 1881822948
Provider Name (Legal Business Name): MICHAEL C ARENA IDMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 SOUTH PHOENIX STREET BLDG 4843
TUCSON AZ
85707-0000
US

IV. Provider business mailing address

4625 SOUTH PHOENIX STREET BLDG 4843, DAVIS MONTHAN AFB
TUCSON AZ
85707
US

V. Phone/Fax

Practice location:
  • Phone: 520-228-4848
  • Fax: 520-228-6458
Mailing address:
  • Phone: 520-228-4848
  • Fax: 520-228-6458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: