NPIMap

Organization Active NPI

Lake Mi Mobile Doctors, P.C.

Doing business as Mobile Doctors of Phoenix

  • Geriatric Medicine (Family Medicine) Physician
  • Phoenix, AZ
National Provider Identifier
1851612329
Registry record updated Oct 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
LAKE MI MOBILE DOCTORS, P.C.
Doing business as
Mobile Doctors of Phoenix
Practice address
2345 E. Thomas Rd
Suite # 420
Phoenix, AZ 85016
Phone
(602) 955-5700
Fax
(602) 955-5701
NPI assigned
Jun 18, 2010
Last updated
Oct 9, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tysyn Contreras
Title
Director, Quality Assurance
Phone
(773) 751-7200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X NU Primary

Addresses

Primary practice location

2345 E. Thomas Rd
Suite # 420
Phoenix, AZ 85016

Mailing address

3319 N Elston Ave
Suite 200
Chicago, IL 60618-5811
Phone (773) 751-7200

Other identifiers 1

IdentifierTypeStateIssuer
574693MedicaidAZ

Other names 1

  • Mobile Doctors of Phoenix Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349740800000",
    "number": "1851612329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3319 N ELSTON AVE",
            "address_2": "SUITE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606185811",
            "telephone_number": "773-751-7200",
            "fax_number": "773-583-4401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2345 E. THOMAS RD",
            "address_2": "SUITE # 420",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85016",
            "telephone_number": "602-955-5700",
            "fax_number": "602-955-5701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MI MOBILE DOCTORS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-18",
        "last_updated": "2012-10-09",
        "status": "A",
        "authorized_official_last_name": "CONTRERAS",
        "authorized_official_first_name": "TYSYN",
        "authorized_official_title_or_position": "DIRECTOR, QUALITY ASSURANCE",
        "authorized_official_telephone_number": "773-751-7200"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "574693",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mobile Doctors of Phoenix",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.