Provider Demographics
NPI:1134182744
Name:JOO, MIHAE GRACE (MD)
Entity type:Individual
Prefix:
First Name:MIHAE
Middle Name:GRACE
Last Name:JOO
Suffix:
Gender:F
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 708850
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-8850
Mailing Address - Country:US
Mailing Address - Phone:800-846-5314
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:6644 E BAYWOOD AVE
Practice Address - Street 2:APOGEE MEDICAL GROUP
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1747
Practice Address - Country:US
Practice Address - Phone:480-321-4391
Practice Address - Fax:480-981-4624
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD20030642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM63224861Medicaid
NMH65999Medicare UPIN