Provider Demographics
NPI:1093973505
Name:M & M MEDICAL P.C.
Entity Type:Organization
Organization Name:M & M MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FILNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-487-3334
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3383207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0840950OtherBCBS
AZ641417Medicaid
AZF00981OtherPHOENIX HEALTH PLAN
AZ52892OtherAETNA
AZ1Z7949OtherHEALTHNET
AZ52892OtherAETNA
AZF00981OtherPHOENIX HEALTH PLAN