Provider Demographics
NPI:1164685491
Name:SAN TAN INTERNAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:SAN TAN INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:YALAMANCHILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-813-6699
Mailing Address - Street 1:PO BOX 11970
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-0017
Mailing Address - Country:US
Mailing Address - Phone:480-813-6699
Mailing Address - Fax:480-813-6697
Practice Address - Street 1:4135 S POWER RD
Practice Address - Street 2:#120
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3624
Practice Address - Country:US
Practice Address - Phone:480-813-6699
Practice Address - Fax:480-813-6697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty