Provider Demographics
NPI:1992820559
Name:MICRODOSE INTERNATIONAL INC
Entity type:Organization
Organization Name:MICRODOSE INTERNATIONAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:I
Authorized Official - Last Name:STENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:480-983-8376
Mailing Address - Street 1:6641 E. BAYWOOD AVE
Mailing Address - Street 2:STE. C-2
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1723
Mailing Address - Country:US
Mailing Address - Phone:480-983-8376
Mailing Address - Fax:480-671-5860
Practice Address - Street 1:201 W APACHE TRL
Practice Address - Street 2:SUITE 710
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220-3942
Practice Address - Country:US
Practice Address - Phone:480-983-8376
Practice Address - Fax:480-671-5860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty