Healthcare Provider Details

I. General information

NPI: 1598986630
Provider Name (Legal Business Name): MI LE TRAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 N TATUM BLVD SUITE 103
PHOENIX AZ
85028-1607
US

IV. Provider business mailing address

11110 N TATUM BLVD SUITE 103
PHOENIX AZ
85028-1607
US

V. Phone/Fax

Practice location:
  • Phone: 601-443-0400
  • Fax: 602-443-0401
Mailing address:
  • Phone: 601-443-0400
  • Fax: 602-443-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number22239
License Number StateAZ

VIII. Authorized Official

Name: DR. MI LE TRAN
Title or Position: PRESIDENT
Credential: MD
Phone: 602-443-0400