Basic Information
| Provider Information | |||||||||
| NPI: | 1699782565 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PROBSTFELD | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6422 E SPEEDWAY BLVD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857101149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203183004 | ||||||||
| FaxNumber: | 5203183061 | ||||||||
| Practice Location | |||||||||
| Address1: | 6422 E SPEEDWAY BLVD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857101149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203183004 | ||||||||
| FaxNumber: | 5203183061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 05/22/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25850 | AZ | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 10042 | 01 | AZ | PACIFICARE | OTHER | 400789-07 | 01 | AZ | AHCCCS | OTHER | AZ0153320 | 01 | AZ | BCBS | OTHER | 2Z3169 | 01 | AZ | HEALTH NET | OTHER | 203604285 | 01 | AZ | UNITED | OTHER |