MEDICARE: MICHAEL JAMES PORTER 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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1053928374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JAMES PORTER PA-C

Provider Business Mailing Address
First Line	:	1060 E SOUTHERN AVE STE 106
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-5058
Country	:	US
Telephone Number	:	480-870-7400
Fax Number	:	480-906-2174

Provider Business Practice Location Address
First Line	:	1060 E SOUTHERN AVE STE 106
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-5058
Country	:	US
Telephone Number	:	480-870-7400
Fax Number	:	480-906-2174

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

Provider Enumeration Date	:	09/30/2020
Last Update Date	:	07/18/2024

Similar Medicare Providers

1396278719 — DR. CASSIDY ELIZABETH PATTIK M.D.
Practice Location Address:

1060 E SOUTHERN AVE STE 106
MESA, AZ
85204-5058

Practice Phone: 480-870-7400
Practice Fax: 480-906-2174

1700116605 — DR. CUAUHTEMOC GALLARDO-PRADO M.D.
Practice Location Address:

1060 E SOUTHERN AVE STE 106
MESA, AZ
85204-5058

Practice Phone: 480-870-7400
Practice Fax: 480-906-2174

1932563392 — LEIGH ANNE COSTANZO
Practice Location Address:

1060 E SOUTHERN AVE STE 106
MESA, AZ
85204-5058

Practice Phone: 480-610-7100
Practice Fax: 480-870-7402

1477218600 — MS. MONICA C REYES RN
Practice Location Address:

1060 E SOUTHERN AVE STE 106
MESA, AZ
85204-5058

Practice Phone: 808-707-4004
Practice Fax: 480-870-7402

1750687786 — MOHAMMAD MUSSADIQ KHAN M.D.
Practice Location Address:

4245 ALTURA MESA LN NE
ALBUQUERQUE, NM
87110-5058

Practice Phone: 505-349-4288
Practice Fax:

1407219140 — DR. KYLE RATLIFF DDS
Practice Location Address:

5058 E. STILL CIRCLE
MESA, AZ
85206

Practice Phone: 480-219-6000
Practice Fax:

Directions to “ MICHAEL JAMES PORTER PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.