Basic Information
| Provider Information | |||||||||
| NPI: | 1679538441 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA OTOLARYNGOLOGY CONSULTANTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2222 E HIGHLAND AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850164876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022644834 | ||||||||
| FaxNumber: | 6022545178 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 E HIGHLAND AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850164876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022644834 | ||||||||
| FaxNumber: | 6022545178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | MILLIGAN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6022644834 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 01/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 799702 | 05 | AZ | MEDICAID |