Provider Demographics
NPI:1972595940
Name:SACKETT, SEAN K (DO)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:K
Last Name:SACKETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 N CENTRAL AVE STE 1175
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-0002
Mailing Address - Country:US
Mailing Address - Phone:888-698-6727
Mailing Address - Fax:602-564-6246
Practice Address - Street 1:21321 E OCOTILLO RD STE 133
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5995
Practice Address - Country:US
Practice Address - Phone:480-987-5525
Practice Address - Fax:480-987-5115
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ879174Medicaid
AZ103360Medicare ID - Type UnspecifiedINDIVIDUAL
AZ879174Medicaid
AZI12850Medicare UPIN