Provider Demographics
NPI:1114219789
Name:GHANTA, SASI KRISHNA (MD)
Entity Type:Individual
Prefix:
First Name:SASI
Middle Name:KRISHNA
Last Name:GHANTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:525S WATSON RD 200
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-3451
Mailing Address - Country:US
Mailing Address - Phone:623-882-9161
Mailing Address - Fax:623-925-0745
Practice Address - Street 1:6950 E GOLF LINKS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-1017
Practice Address - Country:US
Practice Address - Phone:520-670-3909
Practice Address - Fax:520-309-3278
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2015-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ44088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine