MEDICARE: MICHAEL C ARENA IDMT

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	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1881822948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL C ARENA IDMT

Provider Business Mailing Address
First Line	:	4625 SOUTH PHOENIX STREET
Second Line	:	BLDG 4843, DAVIS MONTHAN AFB
City	:	TUCSON
State	:	AZ
Zip	:	85707
Country	:	US
Telephone Number	:	520-228-4848
Fax Number	:	520-228-6458

Provider Business Practice Location Address
First Line	:	4625 SOUTH PHOENIX STREET
Second Line	:	BLDG 4843
City	:	TUCSON
State	:	AZ
Zip	:	85707-0000
Country	:	US
Telephone Number	:	520-228-4848
Fax Number	:	520-228-6458

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

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	06/29/2009

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