Provider Demographics
NPI:1871293514
Name:CANDELARIO TIRADO, MICHAEL JAMIL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMIL
Last Name:CANDELARIO TIRADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 N LA CHOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3535
Mailing Address - Country:US
Mailing Address - Phone:520-297-0404
Mailing Address - Fax:
Practice Address - Street 1:5910 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3535
Practice Address - Country:US
Practice Address - Phone:520-297-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPA-1411363A00000X
AZ9944363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant