Provider Demographics
NPI:1003302480
Name:MD CENTERS LLC
Entity Type:Organization
Organization Name:MD CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MITRESKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-893-5232
Mailing Address - Street 1:7814 N VIA DE LA MONTANA
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7814 N VIA DE LA MONTANA
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3303
Practice Address - Country:US
Practice Address - Phone:480-848-1428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty