Basic Information
Provider Information
NPI: 1073956173
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CARCHEDI
FirstName: MICHAEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 33269
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850673269
CountryCode: US
TelephoneNumber: 6024064786
FaxNumber: 9166364358
Practice Location
Address1: 500 W THOMAS RD STE 900A
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850134223
CountryCode: US
TelephoneNumber: 6024063540
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/09/2013
LastUpdateDate: 07/13/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XDR.0059237CON Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X009040AZY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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