Healthcare Provider Details

I. General information

NPI: 1649222480
Provider Name (Legal Business Name): JAMES ALLEN ENGELHART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 WILSON TER
GLENDALE CA
91206-4007
US

IV. Provider business mailing address

2200 N MAYFAIR RD SUITE 200
WAUWATOSA WI
53226-2252
US

V. Phone/Fax

Practice location:
  • Phone: 818-409-8000
  • Fax: 775-785-8731
Mailing address:
  • Phone: 414-258-9511
  • Fax: 414-607-3946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberM8538
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM8538
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG56010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: