Provider Demographics
NPI:1003982059
Name:FILNER, IVAN MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:MICHAEL
Last Name:FILNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15182 N 75TH AVE
Mailing Address - Street 2:180
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4722
Mailing Address - Country:US
Mailing Address - Phone:623-487-3334
Mailing Address - Fax:623-487-3656
Practice Address - Street 1:15182 N 75TH AVE
Practice Address - Street 2:180
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4722
Practice Address - Country:US
Practice Address - Phone:623-487-3334
Practice Address - Fax:623-487-3656
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3383207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF00981OtherPHOENIX HEALTH PLAN
AZ460840Medicaid
AZAZ0840950OtherBCBS
AZ1Z7949OtherHEALTHNET
AZ52892OtherAETNA
AZ460840Medicaid
AZZ26739Medicare PIN