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NPI Code Detail

MEDICARE: MRS. MICHELLE LYNN BERTOLINO-THOMAS PA - C

MEDICARE: MRS. MICHELLE LYNN BERTOLINO-THOMAS 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 Assistant2862AZ

Other Identifiers

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

General Provider Information

NPI Number : 1841285699
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELLE LYNN BERTOLINO-THOMAS PA - C
Provider Business Mailing Address
First Line : 6226 E PIMA ST STE 100
Second Line :
City : TUCSON
State : AZ
Zip : 85712-7003
Country : US
Telephone Number : 520-298-7200
Fax Number :
Provider Business Practice Location Address
First Line : 6226 E PIMA ST STE 100
Second Line :
City : TUCSON
State : AZ
Zip : 85712-7003
Country : US
Telephone Number : 520-298-7200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2005
Last Update Date : 09/30/2021

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Directions to “ MRS. MICHELLE LYNN BERTOLINO-THOMAS PA - C” Practice Location

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