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General NPI Number Information
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NPI Number | 1356336317
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Entity Type | Individual
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Provider Name | MICHAEL N DESVIGNE M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/15/2005
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 6320 W. UNION HILLS DR, BLDG A, STE 140
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City | GLENDALE
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State | AZ
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Zip | 85308
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Country | US
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Telephone | 480-471-8700
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Fax | 480-588-3795
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Provider Business Mailing Address
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Address Line | 6320 W. UNION HILLS DR, BLDG A, STE 140
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City | GLENDALE
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State | AZ
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Zip | 85308
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Country | US
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Telephone | 480-471-8700
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Fax | 480-588-3795
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | G70657
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 35062
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License Number State | AZ
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