Basic Information
Provider Information
NPI: 1679535165
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROCK
FirstName: MICHAEL
MiddleName: V.
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3707 N 7TH ST
Address2: SUITE 305
City: PHOENIX
State: AZ
PostalCode: 850145059
CountryCode: US
TelephoneNumber: 6022649100
FaxNumber: 6022656955
Practice Location
Address1: 1520 S DOBSON RD
Address2: SUITE 302
City: MESA
State: AZ
PostalCode: 852024725
CountryCode: US
TelephoneNumber: 4804611088
FaxNumber: 4804611657
Other Information
ProviderEnumerationDate: 04/03/2006
LastUpdateDate: 05/19/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100X9083AZY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

No ID Information.


Home