Healthcare Provider Details

I. General information

NPI: 1780804229
Provider Name (Legal Business Name): MITCHELL TRAVIS GADOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 S. VAL VISTA DRIVE
GILBERT AZ
85297
US

IV. Provider business mailing address

25500 N. NORTERRA PARKWAY, BLDG B
PHOENIX AZ
85085
US

V. Phone/Fax

Practice location:
  • Phone: 480-722-2340
  • Fax: 480-722-2360
Mailing address:
  • Phone: 623-277-1000
  • Fax: 602-906-2789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301086523
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: