Provider Demographics
NPI:1437439361
Name:MIRGELER, MINDI (PAC)
Entity Type:Individual
Prefix:MS
First Name:MINDI
Middle Name:
Last Name:MIRGELER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MINDI
Other - Middle Name:
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:2550 N THUNDERBIRD CIR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1214
Mailing Address - Country:US
Mailing Address - Phone:480-924-8382
Mailing Address - Fax:480-924-8339
Practice Address - Street 1:2550 N THUNDERBIRD CIR
Practice Address - Street 2:SUITE 303
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1214
Practice Address - Country:US
Practice Address - Phone:480-924-8382
Practice Address - Fax:480-924-8339
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3366363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ03D0959991Medicaid
AZG44299Medicare UPIN