Provider Demographics
NPI:1861493439
Name:METELITS, JOEL (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:METELITS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5151 E BROADWAY RD STE 107
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1346
Mailing Address - Country:US
Mailing Address - Phone:480-290-7000
Mailing Address - Fax:602-254-6840
Practice Address - Street 1:5750 W THUNDERBIRD RD STE E500
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4669
Practice Address - Country:US
Practice Address - Phone:602-938-6960
Practice Address - Fax:602-938-6069
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ13427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ226879OtherMEDICARE
AZCD5921Medicare PIN