Healthcare Provider Details

I. General information

NPI: 1952696643
Provider Name (Legal Business Name): MICHAEL A MOHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 E INVERNESS AVE SUITE 112
MESA AZ
85206-4630
US

IV. Provider business mailing address

PO BOX 30388
MESA AZ
85275-0388
US

V. Phone/Fax

Practice location:
  • Phone: 480-830-3900
  • Fax:
Mailing address:
  • Phone: 480-361-0124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL-248367
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number52665
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: