Basic Information
| Provider Information | |||||||||
| NPI: | 1669590543 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOLITOR | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | STEVEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 E CAMELBACK RD | ||||||||
| Address2: | STE 250 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850182327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029331814 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1920 E CAMBRIDGE AVE | ||||||||
| Address2: | SUITE #201 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850061459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022545561 | ||||||||
| FaxNumber: | 6022542185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 03/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | 4301088111 | MI | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | 47558 | AZ | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0120X | 7947793-1205 | UT | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | 4301088111 | MI | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0127X | 47558 | AZ | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0120X | 47558 | AZ | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
No ID Information.