Provider Demographics
NPI:1215168059
Name:SANNA, SATHISH (MBBS)
Entity type:Individual
Prefix:
First Name:SATHISH
Middle Name:
Last Name:SANNA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:6622 N 91ST AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2569
Mailing Address - Country:US
Mailing Address - Phone:602-759-6883
Mailing Address - Fax:602-224-3358
Practice Address - Street 1:14506 W GRANITE VALLEY DR STE 113
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375
Practice Address - Country:US
Practice Address - Phone:623-289-9345
Practice Address - Fax:623-972-2038
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ50093207RC0200X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ029778Medicaid
AZZ178170Medicare PIN