Healthcare Provider Details

I. General information

NPI: 1942347711
Provider Name (Legal Business Name): PHILLIP I MENASHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6970 E CHAUNCEY LN STE 100
PHOENIX AZ
85054-5158
US

IV. Provider business mailing address

6970 E CHAUNCEY LN STE 100
PHOENIX AZ
85054-5158
US

V. Phone/Fax

Practice location:
  • Phone: 602-788-7211
  • Fax: 602-788-1890
Mailing address:
  • Phone: 602-788-7221
  • Fax: 602-788-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD00019238
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD00019238
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number57205
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: