Basic Information
Provider Information
NPI: 1003015918
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STUMPF
FirstName: MICHAEL
MiddleName: J.
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 29455 N CAVE CREEK RD STE #118-451
Address2:  
City: PHX
State: AZ
PostalCode: 85331
CountryCode: US
TelephoneNumber: 8444367874
FaxNumber: 8553841967
Practice Location
Address1: 20401 N. 73RD ST. STE #155
Address2:  
City: SCOTTSDALE
State: AZ
PostalCode: 85255
CountryCode: US
TelephoneNumber: 8444367874
FaxNumber: 8553841967
Other Information
ProviderEnumerationDate: 07/12/2007
LastUpdateDate: 11/01/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X4658AZY Allopathic & Osteopathic PhysiciansSurgery 
208600000XOS10828FLN Allopathic & Osteopathic PhysiciansSurgery 

ID Information
IDTypeStateIssuerDescription
27079505AZ MEDICAID


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