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NPI Code Detail

MEDICARE: MS. AMY ELIZABETH MICELI PA-C

MEDICARE: MS. AMY ELIZABETH MICELI 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
1363AM0700XMedical Physician Assistant4964AZ

General Provider Information

NPI Number : 1073894374
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMY ELIZABETH MICELI PA-C
Provider Business Mailing Address
First Line : 4510 E MICHIGAN AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85032-1586
Country : US
Telephone Number : 602-618-1177
Fax Number : 623-869-9090
Provider Business Practice Location Address
First Line : 2030 W WHISPERING WIND DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85085-2853
Country : US
Telephone Number : 623-869-9080
Fax Number : 623-869-9090
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2011
Last Update Date : 11/06/2014

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