Healthcare Provider Details

I. General information

NPI: 1366494312
Provider Name (Legal Business Name): MITCHELL IRA COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E CAMBRIDGE AVE SUITE 301
PHOENIX AZ
85006
US

IV. Provider business mailing address

1920 E CAMBRIDGE SUITE 301
PHOENIX AZ
85006
US

V. Phone/Fax

Practice location:
  • Phone: 602-253-6000
  • Fax: 602-256-2878
Mailing address:
  • Phone: 602-253-6000
  • Fax: 602-256-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number30601
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: