Individual
DR. STACY DEANN VELDHUIZEN MICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7165 E UNIVERSITY DR STE 101, MESA, AZ 85207-6400
(480) 999-0049
(866) 918-8525
Mailing address
3815 E BELL RD STE 2200, PHOENIX, AZ 85032-2139
(602) 633-3848
(602) 633-3841
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31691
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260027308
TAX ID
AZ
01
—
2Z1949
HEALTHNET
—
05
—
834764001
—
AZ
01
—
860783428
TAX ID
AZ
01
—
AZ0773670
BLUE CROSS BLUE SHIELD
—
Enumeration date
04/27/2006
Last updated
09/21/2023
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