MEDICARE: MICHAEL A MOHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	L-248367	MA
2	2080S0012X	Pediatric Sleep Medicine Physician	52665	AZ

General Provider Information

NPI Number	:	1952696643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL A MOHAN MD

Provider Business Mailing Address
First Line	:	PO BOX 30388
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85275-0388
Country	:	US
Telephone Number	:	480-361-0124
Fax Number	:

Provider Business Practice Location Address
First Line	:	4555 E INVERNESS AVE
Second Line	:	SUITE 112
City	:	MESA
State	:	AZ
Zip	:	85206-4630
Country	:	US
Telephone Number	:	480-830-3900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2011
Last Update Date	:	10/10/2016

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Directions to “ MICHAEL A MOHAN MD” Practice Location

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