=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336384809
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IRWIN W TISCHLER D.O
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2008
-----------------------------------------------------
Last Update Date | 12/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4638 E BERNEIL DR
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85028-5500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-538-2200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4638 E BERNEIL DR
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85028-5500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-538-2200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 2738
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------