Individual
DR. MICHAEL MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 214-2920
(928) 214-2925
Mailing address
1200 N BEAVER ST, PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 773-2559
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
005862
AZ
207R00000X
Internal Medicine Physician
R1693
AZ
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
005862
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
716555
—
AZ
Enumeration date
06/09/2009
Last updated
08/02/2021
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