Basic Information
| Provider Information | |||||||||
| NPI: | 1326121682 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IVAN | ||||||||
| FirstName: | DANIELA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | IVAN | ||||||||
| OtherFirstName: | DANIELA | ||||||||
| OtherMiddleName: | DUSE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1900 N HIGLEY ROAD | ||||||||
| Address2: | ATTN: HOSPITALISTS | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805432034 | ||||||||
| FaxNumber: | 4805432647 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 N HIGLEY RD | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852341604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805432034 | ||||||||
| FaxNumber: | 4805432647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 01/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 37560 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 37560 | AZ | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.