Provider Demographics
NPI:1497998975
Name:AMIT A SAHASRABUDHE MD PC
Entity Type:Organization
Organization Name:AMIT A SAHASRABUDHE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAHASRABUDHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-889-1838
Mailing Address - Street 1:8630 E VIA DE VENTURA STE 105
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3340
Mailing Address - Country:US
Mailing Address - Phone:480-889-1838
Mailing Address - Fax:480-889-1917
Practice Address - Street 1:8630 E VIA DE VENTURA STE 105
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3340
Practice Address - Country:US
Practice Address - Phone:480-889-1838
Practice Address - Fax:480-889-1917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36788207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ129440Medicare PIN