Provider Demographics
NPI:1114911203
Name:SANGHI, VINAY BHUSHAN (MD)
Entity Type:Individual
Prefix:
First Name:VINAY
Middle Name:BHUSHAN
Last Name:SANGHI
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 1:1590 PASEO SAN LUIS STE 102
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4783
Mailing Address - Country:US
Mailing Address - Phone:520-335-2400
Mailing Address - Fax:520-335-1288
Practice Address - Street 1:1940 E WILCOX ST
Practice Address - Street 2:STE 102
Practice Address - City:SIERRA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-335-2400
Practice Address - Fax:877-669-0381
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ53705207RC0000X, 207RI0011X
IL036-099975207RI0011X
FLME88848207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269125600Medicaid
FL82010OtherBCBS
FL82010ZMedicare ID - Type Unspecified