Healthcare Provider Details

I. General information

NPI: 1952301228
Provider Name (Legal Business Name): IRA EHRLICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E PALM LN SUITE 175
PHOENIX AZ
85004-4603
US

IV. Provider business mailing address

340 E PALM LN SUITE 175
PHOENIX AZ
85004-4603
US

V. Phone/Fax

Practice location:
  • Phone: 602-386-1100
  • Fax: 602-386-1150
Mailing address:
  • Phone: 602-386-1100
  • Fax: 602-386-1150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5316
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: