Provider Demographics
NPI:1699782565
Name:PROBSTFELD, MICHAEL R (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:PROBSTFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6422 E SPEEDWAY BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1149
Mailing Address - Country:US
Mailing Address - Phone:520-318-3004
Mailing Address - Fax:520-318-3061
Practice Address - Street 1:2424 N WYATT DR STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6119
Practice Address - Country:US
Practice Address - Phone:520-324-8621
Practice Address - Fax:520-324-3935
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ25850208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ203604285OtherUNITED
AZAZ0153320OtherBCBS
AZ400789-07OtherAHCCCS
AZ10042OtherPACIFICARE
AZ2Z3169OtherHEALTH NET
AZAZ0153320OtherBCBS
AZ400789-07OtherAHCCCS
AZ10042OtherPACIFICARE