Healthcare Provider Details

I. General information

NPI: 1891744348
Provider Name (Legal Business Name): MICHAEL OWEN DAINES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 N WILMOT RD SUITE #101
TUCSON AZ
85711
US

IV. Provider business mailing address

2701 E ELVIRA RD
TUCSON AZ
85756-7214
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-9988
  • Fax: 520-694-9917
Mailing address:
  • Phone: 520-626-7780
  • Fax: 520-626-9465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number35.077542
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number36281
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: