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Contact Information

ALICIA MANGRAM, MD
16601 N 40TH ST STE 204
PHOENIX, AZ85032-3356
 Phone: 602-633-3721
 Fax: 602-595-1127
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgical Critical Care

2086S0102X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for ALICIA MANGRAM · (Female)

NPI # 1972575504
Status Active
Credentials MD
Entity Individual
Enumeration date 02/07/2006
Last updated 10/21/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • AZ License # 45385
  • AZ Medicaid 665273
  • TX Medicaid 144729405
Hospital affiliation(s)
  • JOHN C LINCOLN NORTH MOUNTAIN HOSPITAL - (Acute Care)
    250 EAST DUNLAP AVENUE
    PHOENIX, AZ 85020
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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