MEDICARE: MICHAEL D SWEETEN PAC

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	363AM0700X	Medical Physician Assistant	2901	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1059873	OTHER	AZ	NATIONAL CERTIFICATION
2	2901	OTHER	AZ	STATE LICENSE

General Provider Information

NPI Number	:	1952520058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL D SWEETEN PAC

Provider Business Mailing Address
First Line	:	5946 W KESLER LN
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85226-4488
Country	:	US
Telephone Number	:	480-363-3987
Fax Number	:

Provider Business Practice Location Address
First Line	:	4530 E MUIRWOOD DR STE 110
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-7693
Country	:	US
Telephone Number	:	480-763-5808
Fax Number	:

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	03/07/2023

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Directions to “ MICHAEL D SWEETEN PAC” Practice Location

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