Provider Demographics
NPI:1629057153
Name:SAMANT, ANIL R (MD)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:R
Last Name:SAMANT
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 1:10503 W THUNDERBIRD BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3022
Mailing Address - Country:US
Mailing Address - Phone:623-974-3649
Mailing Address - Fax:623-974-8364
Practice Address - Street 1:10503 W THUNDERBIRD BLVD
Practice Address - Street 2:SUITE103
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3022
Practice Address - Country:US
Practice Address - Phone:623-974-3649
Practice Address - Fax:623-974-8364
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10949207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
D37569Medicare UPIN
ZWCHCC02Medicare ID - Type Unspecified