Healthcare Provider Details

I. General information

NPI: 1578744793
Provider Name (Legal Business Name): RODNEY S IANCOVICI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7516 E MAIN ST STE 4
MESA AZ
85207-8332
US

IV. Provider business mailing address

PO BOX 6643
MESA AZ
85216-6643
US

V. Phone/Fax

Practice location:
  • Phone: 480-807-9400
  • Fax: 480-807-7946
Mailing address:
  • Phone: 480-807-9400
  • Fax: 480-807-7946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. RODNEY SIMION IANCOVICI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 480-807-9400