MEDICARE: MICHAEL MILLETTE PA-C

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	363A00000X	Physician Assistant	2866	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043259591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL MILLETTE PA-C

Provider Business Mailing Address
First Line	:	801 W AZURE LN
Second Line	:
City	:	LITCHFIELD PARK
State	:	AZ
Zip	:	85340-5087
Country	:	US
Telephone Number	:	623-882-1331
Fax Number	:

Provider Business Practice Location Address
First Line	:	13838 S 46TH PL
Second Line	:	SUITE 115
City	:	PHOENIX
State	:	AZ
Zip	:	85044-7800
Country	:	US
Telephone Number	:	480-496-0000
Fax Number	:	480-496-7235

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	01/21/2025

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Directions to “ MICHAEL MILLETTE PA-C” Practice Location

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