Healthcare Provider Details

I. General information

NPI: 1457378143
Provider Name (Legal Business Name): HAROLD KEITH SARTORIUS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

IV. Provider business mailing address

1300 N 12TH ST SUITE 301
PHOENIX AZ
85006-2848
US

V. Phone/Fax

Practice location:
  • Phone: 602-239-6968
  • Fax: 602-239-4144
Mailing address:
  • Phone: 602-239-6968
  • Fax: 602-239-4144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2384
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2384
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: