Provider Demographics
NPI:1295260180
Name:TARR, SONDEMA NKIPMO (DPM)
Entity type:Individual
Prefix:DR
First Name:SONDEMA
Middle Name:NKIPMO
Last Name:TARR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 772294
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2294
Mailing Address - Country:US
Mailing Address - Phone:847-504-5000
Mailing Address - Fax:844-554-5510
Practice Address - Street 1:4685 S ASH AVE # SITEH1
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6857
Practice Address - Country:US
Practice Address - Phone:602-638-2718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPOD-000969213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty