Individual
CHARLES MILITELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3638 E SOUTHERN AVE STE C108, MESA, AZ 85206-2564
(480) 834-0771
(480) 834-1136
Mailing address
3638 E SOUTHERN AVE STE C108, MESA, AZ 85206-2564
(480) 834-0771
(480) 834-1136
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
8487
AZ
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
095004
—
AZ
Enumeration date
05/25/2006
Last updated
11/17/2025
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