Basic Information
| Provider Information | |||||||||
| NPI: | 1750776910 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURANDO | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | LUCA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D.-PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 910221 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753910221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205197700 | ||||||||
| FaxNumber: | 6234873737 | ||||||||
| Practice Location | |||||||||
| Address1: | 7200 W BELL RD BLDG A | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853088529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6234874822 | ||||||||
| FaxNumber: | 6233349881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2015 | ||||||||
| LastUpdateDate: | 03/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD467345 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | 12243243-1205 | UT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 61229 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RX0202X | 12243243 | UT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | U000110687 | 01 | UT | MEDICARE PTAN | OTHER |