Provider Demographics
NPI:1528048006
Name:AMOLS, MARK H (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:AMOLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4824 E BASELINE RD
Mailing Address - Street 2:SUITE 132
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4676
Mailing Address - Country:US
Mailing Address - Phone:480-351-8222
Mailing Address - Fax:480-351-8221
Practice Address - Street 1:4824 E BASELINE RD
Practice Address - Street 2:SUITE 132
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4676
Practice Address - Country:US
Practice Address - Phone:480-351-8222
Practice Address - Fax:480-351-8221
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN47602207VX0000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN998170500Medicaid
MN998170500Medicaid
MN160002493Medicare PIN
MN160003131Medicare PIN