Provider Demographics
NPI:1215991617
Name:SANTHANAKRISHNAN, SUNIL (MD)
Entity type:Individual
Prefix:
First Name:SUNIL
Middle Name:
Last Name:SANTHANAKRISHNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5090 NORTH 40TH STREET
Mailing Address - Street 2:SUITE 122
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018
Mailing Address - Country:US
Mailing Address - Phone:602-264-5685
Mailing Address - Fax:602-631-9870
Practice Address - Street 1:5090 NORTH 40TH STREET
Practice Address - Street 2:SUITE 122
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018
Practice Address - Country:US
Practice Address - Phone:602-264-5685
Practice Address - Fax:602-631-9870
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26044207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
72778Medicare ID - Type Unspecified
G70611Medicare UPIN