MEDICARE: MICHAEL MCCLAFLIN

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	332B00000X	Durable Medical Equipment & Medical Supplies	C001512	AZ

General Provider Information

NPI Number	:	1386167864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL MCCLAFLIN

Provider Business Mailing Address
First Line	:	14438 S 11TH PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-4409
Country	:	US
Telephone Number	:	602-321-2765
Fax Number	:	888-315-7992

Provider Business Practice Location Address
First Line	:	4926 E MCDOWELL RD STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-4294
Country	:	US
Telephone Number	:	602-321-2765
Fax Number	:	888-315-7992

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

Provider Enumeration Date	:	07/17/2017
Last Update Date	:	07/17/2017

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