Provider Demographics
NPI:1417903675
Name:SANDERS, JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 E NORTH AVE
Mailing Address - Street 2:COLUMBIA-ST. MARY'S FAMILY PRACTICE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3515
Mailing Address - Country:US
Mailing Address - Phone:414-267-6502
Mailing Address - Fax:414-267-3892
Practice Address - Street 1:1121 E NORTH AVE
Practice Address - Street 2:COLUMBIA-ST. MARY'S FAMILY PRACTICE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3515
Practice Address - Country:US
Practice Address - Phone:414-267-6502
Practice Address - Fax:414-267-3892
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI45070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1417903675Medicaid
WI31978600Medicaid
008000261POtherHUMANA
008000261POtherHUMANA
0015573601Medicare ID - Type Unspecified