MEDICARE: DR. MICHAEL JOSE ARDAIZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	MD30604	DC

General Provider Information

NPI Number	:	1013111913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOSE ARDAIZ

Provider Business Mailing Address
First Line	:	6428 LEE HWY
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22205-1922
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6428 LEE HWY
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22205-1922
Country	:	US
Telephone Number	:	703-447-8723
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	07/08/2007

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