Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 18-1719 | AZ |
NPI | 1063070126 |
---|---|
Provider Name | Michael Alexander Ptack |
First Address | Scottsdale, AZ 85260-3713 |
Second Address | Scottsdale, AZ 85260-3713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2019 |
Last Update Date | 22/04/2021 |