| NPI | 1083667521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD ALAN MICKLE Owner 480-649-8150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: AZ 2767) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 2767) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2011-10-25 |