MEDICARE: MANOJ MITTAL M.D.

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	29007	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972520708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANOJ MITTAL M.D.

Provider Business Mailing Address
First Line	:	2001 W ORANGE GROVE RD
Second Line	:	STE 510
City	:	TUCSON
State	:	AZ
Zip	:	85704-1139
Country	:	US
Telephone Number	:	520-219-1539
Fax Number	:	520-797-6704

Provider Business Practice Location Address
First Line	:	2001 W ORANGE GROVE RD
Second Line	:	STE 510
City	:	TUCSON
State	:	AZ
Zip	:	85704-1139
Country	:	US
Telephone Number	:	520-219-1539
Fax Number	:	520-797-6704

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

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	12/11/2008

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