Provider Demographics
NPI:1790974863
Name:SACK, PHILIPP ANDREAS (MD)
Entity Type:Individual
Prefix:
First Name:PHILIPP
Middle Name:ANDREAS
Last Name:SACK
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 1:1601 CUMMINS DR STE D
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-6411
Mailing Address - Country:US
Mailing Address - Phone:510-900-3125
Mailing Address - Fax:
Practice Address - Street 1:1601 CUMMINS DR STE D
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-6411
Practice Address - Country:US
Practice Address - Phone:510-900-3125
Practice Address - Fax:504-988-4270
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1337122084P0800X
LA15976R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry