Basic Information
| Provider Information | |||||||||
| NPI: | 1164422085 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDELSTEIN | ||||||||
| FirstName: | MITCHELL | ||||||||
| MiddleName: | E | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3811 E BELL RD | ||||||||
| Address2: | SUITE 309 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850322138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024945040 | ||||||||
| FaxNumber: | 6024944020 | ||||||||
| Practice Location | |||||||||
| Address1: | 3811 E BELL RD | ||||||||
| Address2: | SUITE 309 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850322138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024945040 | ||||||||
| FaxNumber: | 6024944020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2070 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.