Basic Information
| Provider Information | |||||||||
| NPI: | 1003015918 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STUMPF | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29455 N. CAVE CREEK RD STE #118-451 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8444367874 | ||||||||
| FaxNumber: | 8778286834 | ||||||||
| Practice Location | |||||||||
| Address1: | 20940 N. TATUM BLVD. STE #350 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8444367874 | ||||||||
| FaxNumber: | 8778286834 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 05/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | OS10828 | FL | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 4658 | AZ | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 270795 | 05 | AZ | MEDICAID |