Provider Demographics
NPI:1164750782
Name:SIDAT-SINGH, SANKARA ATMAN (MD)
Entity Type:Individual
Prefix:
First Name:SANKARA
Middle Name:ATMAN
Last Name:SIDAT-SINGH
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 1:17220 N BOSWELL BLVD
Mailing Address - Street 2:STE 202W
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-2000
Mailing Address - Country:US
Mailing Address - Phone:623-556-8860
Mailing Address - Fax:623-876-9559
Practice Address - Street 1:17220 N BOSWELL BLVD
Practice Address - Street 2:STE 202W
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-2000
Practice Address - Country:US
Practice Address - Phone:623-556-8860
Practice Address - Fax:623-876-9559
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine