Provider Demographics
NPI:1962615856
Name:SUGIHARA, TOD MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:TOD
Middle Name:MICHAEL
Last Name:SUGIHARA
Suffix:
Gender:
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:8620 N 22ND ST
Mailing Address - Street 2:# 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021
Mailing Address - Country:US
Mailing Address - Phone:602-674-6501
Mailing Address - Fax:602-674-6512
Practice Address - Street 1:2000 W BETHANY HOME RD
Practice Address - Street 2:FAMILY MEDICINE CENTER
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015
Practice Address - Country:US
Practice Address - Phone:602-546-5525
Practice Address - Fax:602-433-6686
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIDOS-2196207Q00000X
AZ4597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ223359Medicaid
AZ223359Medicaid