Basic Information
| Provider Information | |||||||||
| NPI: | 1104037449 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MICHAEL AMOA ASARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2618 E DESERT BROOM PL | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852492463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802034028 | ||||||||
| FaxNumber: | 4808219555 | ||||||||
| Practice Location | |||||||||
| Address1: | 485 S DODSON ROAD | ||||||||
| Address2: | STE 105 | ||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852492463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802034028 | ||||||||
| FaxNumber: | 4808219555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2007 | ||||||||
| LastUpdateDate: | 07/01/2019 | ||||||||
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| AuthorizedOfficialLastName: | AMOA-ASARE | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6026781620 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 31244 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | BA8024654 | 01 | AZ | DEA | OTHER | 77658 | 05 | AZ | MEDICAID |