Individual
MICHAEL A BUMANGLAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9165 W THUNDERBIRD RD, SUITE 200, PEORIA, AZ 85381-4847
(623) 876-3870
(623) 815-0087
Mailing address
13640 N PLAZA DEL RIO BLVD, PEORIA, AZ 85381-4846
(623) 876-3800
(623) 876-6965
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
3446
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164595
—
AZ
01
—
3446
STATE LICENSE
AZ
Enumeration date
06/30/2006
Last updated
12/03/2009
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