Healthcare Provider Details

I. General information

NPI: 1740312974
Provider Name (Legal Business Name): MITCHELL JAMES GIANGOBBE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13629 W CAMINO DEL SOL SUITE 180
SUN CITY WEST AZ
85375-1405
US

IV. Provider business mailing address

13629 W CAMINO DEL SOL SUITE 180
SUN CITY WEST AZ
85375-1405
US

V. Phone/Fax

Practice location:
  • Phone: 623-584-7874
  • Fax: 623-584-8137
Mailing address:
  • Phone: 623-584-7874
  • Fax: 623-584-8137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number23204
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number23204
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: