Basic Information
| Provider Information | |||||||||
| NPI: | 1306885090 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STYLES | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7301 N 16TH ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850205266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804204027 | ||||||||
| FaxNumber: | 6025350940 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 W SAINT MARYS RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857452623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804204027 | ||||||||
| FaxNumber: | 6025350940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 35058128S | OH | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 58240 | AZ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0761484 | 05 | OH | MEDICAID |