Healthcare Provider Details

I. General information

NPI: 1598737363
Provider Name (Legal Business Name): IVAN J ENGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4451 E OAK ST
PHOENIX AZ
85008-2410
US

IV. Provider business mailing address

202 E. EARLL DRIVE SUITE 202
PHOENIX AZ
85012-2647
US

V. Phone/Fax

Practice location:
  • Phone: 602-808-2800
  • Fax: 602-808-2799
Mailing address:
  • Phone: 602-808-2800
  • Fax: 602-808-2799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number44972
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: