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NPI Code Detail

MEDICARE: DR. MICHAEL J DEMANGONE MD

MEDICARE: DR. MICHAEL J DEMANGONE MD
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
1207Q00000XFamily Medicine Physician21633AZ

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 : 1841294378
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL J DEMANGONE MD
Provider Business Mailing Address
First Line : P.O. BOX 790
Second Line :
City : PAGE
State : AZ
Zip : 86040-0790
Country : US
Telephone Number : 928-645-1607
Fax Number : 928-645-3254
Provider Business Practice Location Address
First Line : 463 S LAKE POWELL BLVD
Second Line :
City : PAGE
State : AZ
Zip : 86040-0790
Country : US
Telephone Number : 928-645-0945
Fax Number : 928-645-3254
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 05/27/2011

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Directions to “ DR. MICHAEL J DEMANGONE MD” Practice Location

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