Provider Demographics
NPI:1134208168
Name:LY, SUNTHARO (MD)
Entity type:Individual
Prefix:
First Name:SUNTHARO
Middle Name:
Last Name:LY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 N DOBSON RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4412
Mailing Address - Country:US
Mailing Address - Phone:480-899-2020
Mailing Address - Fax:480-899-9081
Practice Address - Street 1:333 N DOBSON RD
Practice Address - Street 2:SUITE 11
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4412
Practice Address - Country:US
Practice Address - Phone:480-899-2020
Practice Address - Fax:480-899-9081
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30659207R00000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ853508OtherAHCCCS
AZZ124065Medicare PIN
AZ853508OtherAHCCCS