MEDICARE: ARIZONA AGE MANAGEMENT PC

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	261QP2300X	Primary Care Clinic/Center	4509	AZ

General Provider Information

NPI Number	:	1841453123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA AGE MANAGEMENT PC

Provider Business Mailing Address
First Line	:	14362 N FRANK LLOYD WRIGHT BLVD
Second Line	:	SUITE 1000
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-8846
Country	:	US
Telephone Number	:	480-305-5640
Fax Number	:	602-748-4249

Provider Business Practice Location Address
First Line	:	14362 N FRANK LLOYD WRIGHT BLVD
Second Line	:	SUITE 1000
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-8846
Country	:	US
Telephone Number	:	480-305-5640
Fax Number	:	602-748-4249

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL AHMANN
Credential	:	D.O.
Telephone Number	:	480-305-5640

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	07/07/2008

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