Healthcare Provider Details

I. General information

NPI: 1568506186
Provider Name (Legal Business Name): MICHAEL DAVID SECKELER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CAMPBELL AV ROOM 3302
TUCSON AZ
85724
US

IV. Provider business mailing address

BANNER UNIVERSITY MEDICAL CENTER PO BOX 245073
TUCSON AZ
85724
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-5585
  • Fax: 520-626-6571
Mailing address:
  • Phone: 520-626-5585
  • Fax: 520-626-6571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0002X
TaxonomyAdult Congenital Heart Disease Physician
License Number35588
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35588
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number35588
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0418
License Number StateMP
# 5
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number0101245020
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: