Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 31814 | AZ |
N | 208600000X | Surgeon | 31814 | AZ |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 31814 | AZ |
NPI | 1114926300 |
---|---|
Provider Name | Michael C Maxwell |
First Address | Mesa, AZ 85202-6457 |
Second Address | Chandler, AZ 85224-4412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 02/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
819055 | (05) | AZ |
E93863 | (02) | AZ |