MEDICARE: DR. CHRISTIANE M SANBURN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	CS085188	MI
2	207Q00000X	Family Medicine Physician	MD2010-0685	NM
3	207Q00000X	Family Medicine Physician	49418	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	0N27000	OTHER	MA	GROUP MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0808301092	OTHER	MI	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	141170	OTHER	MI	PREF CHOICE
5	CD3061	OTHER	MI	GROUP RR
6	080H310370	OTHER	MA	GROUP BCBS

General Provider Information

NPI Number	:	1518956523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIANE M SANBURN M.D.

Provider Business Mailing Address
First Line	:	5055 E BROADWAY BLVD STE A100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3629
Country	:	US
Telephone Number	:	520-382-1205
Fax Number	:	520-795-0225

Provider Business Practice Location Address
First Line	:	1866 E INNOVATION PARK DR
Second Line	:
City	:	ORO VALLEY
State	:	AZ
Zip	:	85755-1963
Country	:	US
Telephone Number	:	520-825-2520
Fax Number	:	520-825-2501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	06/11/2019

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