Provider Demographics
NPI:1851707293
Name:MI DOCTORA
Entity Type:Organization
Organization Name:MI DOCTORA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-821-3610
Mailing Address - Street 1:2545 W FRYE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6273
Mailing Address - Country:US
Mailing Address - Phone:480-821-3610
Mailing Address - Fax:480-821-3610
Practice Address - Street 1:1142 E SOUTHERN AVE STE C101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5055
Practice Address - Country:US
Practice Address - Phone:480-782-7380
Practice Address - Fax:480-821-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty