Provider Demographics
NPI:1760804991
Name:JARMAN, MIKKEL
Entity Type:Individual
Prefix:DR
First Name:MIKKEL
Middle Name:
Last Name:JARMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 E RAY RD
Mailing Address - Street 2:STE 128
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4200
Mailing Address - Country:US
Mailing Address - Phone:480-497-3946
Mailing Address - Fax:480-497-3947
Practice Address - Street 1:633 E RAY RD
Practice Address - Street 2:STE 128
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4200
Practice Address - Country:US
Practice Address - Phone:480-497-3946
Practice Address - Fax:480-497-3947
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0776213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ896662Medicaid
AZ896662Medicaid