Healthcare Provider Details

I. General information

NPI: 1588891667
Provider Name (Legal Business Name): AMIKAR SEHDEV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 W BEVERLY LN
GLENDALE AZ
85306-1800
US

IV. Provider business mailing address

PO BOX 6423
CHANDLER AZ
85246-6423
US

V. Phone/Fax

Practice location:
  • Phone: 623-312-3000
  • Fax: 623-312-3060
Mailing address:
  • Phone: 233-123-0006
  • Fax: 623-312-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number58218
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: