Healthcare Provider Details

I. General information

NPI: 1891908570
Provider Name (Legal Business Name): GARY J MIHALIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N 44TH ST #400
PHOENIX AZ
85008-7624
US

IV. Provider business mailing address

444 N 44TH ST #400
PHOENIX AZ
85008-7624
US

V. Phone/Fax

Practice location:
  • Phone: 602-685-3846
  • Fax: 602-685-3808
Mailing address:
  • Phone: 602-685-3846
  • Fax: 602-685-3808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number17556
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: