Provider Demographics
NPI:1881702876
Name:SANFORD, ARTHUR PETER (MD)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:PETER
Last Name:SANFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:EMS BLDG
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-9000
Mailing Address - Fax:708-327-3474
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:EMS BLDG 110, ROOM 3227
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-327-2898
Practice Address - Fax:708-327-3474
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77062208600000X
IL036123634208600000X
TXL7546208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H02724Medicare UPIN