Mangram, Alicia

Mangram, Alicia is an individual health care provider with primary practice located at 16601 N 40Th St Ste 204 , Phoenix AZ 85032-3356. She recently has only one registered license in Allopathic & Osteopathic Physicians / Surgical Critical Care, which is considered as her primary health care specialty. Mangram, Alicia can be contacted via phone (602) 633-3721.

Contact Information

Primary practice address
16601 N 40Th St Ste 204 Phoenix AZ 85032-3356
Phone: (602) 633-3721
Fax: (602) 595-1127
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgical Critical Care 2086S0102X 45385 Arizona

Profile Details

NPI number 1972575504
LBN Legal business name Mangram, Alicia
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 7th, 2006
Last updated Oct 21st, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972575504 NPPES
Arizona MEDICAID 665273
Arizona MEDICAID 144729405

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