Provider Demographics
NPI:1598737363
Name:ENGEL, IVAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:J
Last Name:ENGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:202 E. EARLL DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2647
Mailing Address - Country:US
Mailing Address - Phone:602-808-2800
Mailing Address - Fax:602-808-2799
Practice Address - Street 1:4451 E OAK ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-2410
Practice Address - Country:US
Practice Address - Phone:602-808-2800
Practice Address - Fax:602-808-2799
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ449722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ678797Medicaid
NY54596FMedicare ID - Type Unspecified
NYE15702Medicare UPIN