Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 44220 | AZ |
Y | 213ES0000X | Sports Medicine | 44220 | AZ |
N | 2081S0010X | Sports Medicine | 82036 | MA |
N | 213ES0000X | Sports Medicine | 82036 | MA |
NPI | 1497728372 |
---|---|
Provider Name | Dr. Michael G. Crincoli |
First Address | Phoenix, AZ 85006 |
Second Address | Phoenix, AZ 85006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 23/03/2016 |