Provider Demographics
NPI:1134116734
Name:SANSI, PRATIBA K (MD)
Entity Type:Individual
Prefix:
First Name:PRATIBA
Middle Name:K
Last Name:SANSI
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 E 86TH AVE
Mailing Address - Street 2:PO BOX 10645
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6382
Mailing Address - Country:US
Mailing Address - Phone:219-769-1670
Mailing Address - Fax:219-738-6714
Practice Address - Street 1:1201 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8481
Practice Address - Country:US
Practice Address - Phone:219-757-6320
Practice Address - Fax:219-738-6714
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2007-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01057552207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN405600 MMedicare ID - Type Unspecified
IN234800QMedicare PIN
IND14811Medicare UPIN