Provider Demographics
NPI:1356388359
Name:SANIDAS, JOHN GEORGE (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GEORGE
Last Name:SANIDAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:788 N JEFFERSON ST
Mailing Address - Street 2:SUITE 300/ATTN. KAAREN BUTZEN
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3718
Mailing Address - Country:US
Mailing Address - Phone:414-272-8950
Mailing Address - Fax:414-272-0859
Practice Address - Street 1:13133 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE G-18
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-2419
Practice Address - Country:US
Practice Address - Phone:262-243-5000
Practice Address - Fax:262-243-2527
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-11-09
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Provider Licenses
StateLicense IDTaxonomies
WI38112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1356388359Medicaid
WI1356388359Medicaid
WI001373645Medicare UPIN