Provider Demographics
NPI:1790766533
Name:BARGAN, MIKHAIL A (MD)
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:A
Last Name:BARGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53568
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85072-3568
Mailing Address - Country:US
Mailing Address - Phone:623-544-5063
Mailing Address - Fax:623-544-5094
Practice Address - Street 1:15468 N CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-584-2917
Practice Address - Fax:623-584-2945
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9035207Q00000X
AZ32864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
M97623Medicare UPIN