Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 15831 | AZ |
NPI | 1063494326 |
---|---|
Provider Name | Dr. Michael Dimler |
First Address | Phoenix, AZ 85006-1459 |
Second Address | Phoenix, AZ 85006-1459 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 21/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
251546 | (05) | AZ |
B03416 | (02) | AZ |