Provider Demographics
NPI:1427145747
Name:COUCH, MICHAEL W (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:COUCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 N ALVERNON WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-2407
Mailing Address - Country:US
Mailing Address - Phone:520-529-9265
Mailing Address - Fax:520-795-8815
Practice Address - Street 1:3402 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-5406
Practice Address - Country:US
Practice Address - Phone:520-881-0050
Practice Address - Fax:520-795-8815
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18127207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ120952Medicare PIN
AZZ133171Medicare UPIN
AZZ126048Medicare PIN
AZZ133130Medicare UPIN
D36102Medicare UPIN