Provider Demographics
NPI:1558455915
Name:ALVIG, MARI (DO)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:
Last Name:ALVIG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARI
Other - Middle Name:
Other - Last Name:BRODERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:7520 E 2ND ST
Mailing Address - Street 2:STE 1-2
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-4532
Mailing Address - Country:US
Mailing Address - Phone:480-874-2821
Mailing Address - Fax:480-481-0790
Practice Address - Street 1:7520 E 2ND ST
Practice Address - Street 2:STE 1-2
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-4532
Practice Address - Country:US
Practice Address - Phone:480-874-2821
Practice Address - Fax:480-481-0790
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZDO2678Medicare ID - Type Unspecified
AZF70749Medicare UPIN