Individual provider Active NPI

Michelle D Mifflin, DO

  • Family Medicine Physician
  • Glendale, AZ
National Provider Identifier
1598875387
Registry record updated Sep 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
3819 Issued in AZ
Practice address
19389 N 59TH Ave
Glendale, AZ 85308-6500
Phone
(623) 537-6000
Fax
(623) 537-6014
NPI assigned
Aug 30, 2006
Last updated
Sep 29, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 3819 AZ Primary

Addresses

Primary practice location

19389 N 59TH Ave
Glendale, AZ 85308-6500

Mailing address

19389 N 59TH Ave
Glendale, AZ 85308-6500
Phone (623) 537-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050318000466 AZ Practitioner - Family Practice 4688629009 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Midwestern UniversityGroup PAC ID 6305734773, 116 clinicians

Practice addresses (Care Compare)

19389 N 59TH Ave
Glendale, AZ 85308-6500
Phone (623) 537-6000

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
3819AZMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Midwestern University CurrentSince Oct 6, 2014 Accepting new patients
Midwestern University CurrentSince Oct 6, 2014 Accepting new patients
Midwestern University Current Accepting new patients
North Phoenix Medical Center, LTD Family Medicine PastSince Jan 1, 2008 Accepting new patients

Locations

19389 N 59th Ave
Glendale, AZ 85308

26520 Network Pl
Chicago, IL 60673
Phone (630) 743-4500

Interoperability endpoints

  • Direct secure messaging: mmifflin19758@direct.midwestern.edu

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695945600000",
    "number": "1598875387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19389 N 59TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086500",
            "telephone_number": "623-537-6000",
            "fax_number": "623-537-6014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19389 N 59TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086500",
            "telephone_number": "623-537-6000",
            "fax_number": "623-537-6014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIFFLIN",
        "first_name": "MICHELLE",
        "middle_name": "D",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "3819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.