Provider Demographics
NPI:1194722116
Name:SARETSKY, ROBERT A (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:SARETSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6525 W SACK DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7104
Mailing Address - Country:US
Mailing Address - Phone:623-566-2004
Mailing Address - Fax:623-566-2060
Practice Address - Street 1:6525 W SACK DR
Practice Address - Street 2:SUITE 208
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7104
Practice Address - Country:US
Practice Address - Phone:623-566-2004
Practice Address - Fax:623-566-2060
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2007-10-25
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
AZ1578207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE85920Medicare UPIN
AZ77258Medicare ID - Type Unspecified