Provider Demographics
NPI:1508864703
Name:CHESLER, SANFORD MARTIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:MARTIN
Last Name:CHESLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 N 124TH DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-6516
Mailing Address - Country:US
Mailing Address - Phone:623-521-8110
Mailing Address - Fax:623-935-6911
Practice Address - Street 1:2120 N 124TH DR
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6516
Practice Address - Country:US
Practice Address - Phone:623-521-8110
Practice Address - Fax:623-935-6911
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ00145213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ458887Medicaid
AZU73529Medicare UPIN
AZ25449Medicare ID - Type Unspecified