Provider Demographics
NPI:1598986630
Name:MI LE TRAN MD PC
Entity Type:Organization
Organization Name:MI LE TRAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MI
Authorized Official - Middle Name:LE
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-443-0400
Mailing Address - Street 1:11110 N TATUM BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-1607
Mailing Address - Country:US
Mailing Address - Phone:601-443-0400
Mailing Address - Fax:602-443-0401
Practice Address - Street 1:11110 N TATUM BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-1607
Practice Address - Country:US
Practice Address - Phone:601-443-0400
Practice Address - Fax:602-443-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ222392084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ78944Medicare ID - Type UnspecifiedBILLING PROVIDER NUMBER