Provider Demographics
NPI:1518956523
Name:SANBURN, CHRISTIANE M (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIANE
Middle Name:M
Last Name:SANBURN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 E BROADWAY BLVD STE A100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3629
Mailing Address - Country:US
Mailing Address - Phone:520-382-1205
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:1866 E INNOVATION PARK DR
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-1963
Practice Address - Country:US
Practice Address - Phone:520-825-2520
Practice Address - Fax:520-825-2501
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICS085188207Q00000X
NMMD2010-0685207Q00000X
AZ49418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0808301092OtherBCBS
MI4749008Medicaid
AZ947002Medicaid
MI141170OtherPREF CHOICE
MICD3061OtherGROUP RR
MA080H310370OtherGROUP BCBS
MA0N27000OtherGROUP MEDICARE
MA0N27000OtherGROUP MEDICARE
MI4749008Medicaid