Provider Demographics
NPI:1740312974
Name:GIANGOBBE, MITCHELL JAMES (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:JAMES
Last Name:GIANGOBBE
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 1:13629 W CAMINO DEL SOL
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-1405
Mailing Address - Country:US
Mailing Address - Phone:623-584-7874
Mailing Address - Fax:623-584-8137
Practice Address - Street 1:13629 W CAMINO DEL SOL
Practice Address - Street 2:SUITE 180
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-1405
Practice Address - Country:US
Practice Address - Phone:623-584-7874
Practice Address - Fax:623-584-8137
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ232042086S0129X, 208600000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG06514Medicare UPIN
AZZ72042Medicare ID - Type Unspecified