Provider Demographics
NPI:1245686872
Name:EMMANUEL, SAHAN JOSEPH (DO)
Entity type:Individual
Prefix:MR
First Name:SAHAN
Middle Name:JOSEPH
Last Name:EMMANUEL
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 1:1855 N STAPLEY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-3002
Mailing Address - Country:US
Mailing Address - Phone:480-834-7546
Mailing Address - Fax:480-833-8313
Practice Address - Street 1:20928 E HERITAGE LOOP RD STE 106
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-3900
Practice Address - Country:US
Practice Address - Phone:480-834-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ390200000X
AZ7753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program