Provider Demographics
NPI:1073517645
Name:SANDER, ANNA MARIE C (DO)
Entity type:Individual
Prefix:
First Name:ANNA MARIE
Middle Name:C
Last Name:SANDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12677 BROOKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-5955
Mailing Address - Country:US
Mailing Address - Phone:317-219-5188
Mailing Address - Fax:
Practice Address - Street 1:12677 BROOKHAVEN DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-5955
Practice Address - Country:US
Practice Address - Phone:317-219-5188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002192207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200412050Medicaid
IN000000270638OtherANTHEM BXBS
INF56821Medicare UPIN
IN000000270638OtherANTHEM BXBS