Basic Information
| Provider Information | |||||||||
| NPI: | 1790766533 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARGAN | ||||||||
| FirstName: | MIKHAIL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 53568 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850723568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235445063 | ||||||||
| FaxNumber: | 6235445094 | ||||||||
| Practice Location | |||||||||
| Address1: | 15468 N CIVIC CENTER DR | ||||||||
| Address2: | |||||||||
| City: | SURPRISE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235842917 | ||||||||
| FaxNumber: | 6235842945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 07/05/2019 | ||||||||
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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 | 207Q00000X | L9035 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 32864 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.