Healthcare Provider Details

I. General information

NPI: 1801840384
Provider Name (Legal Business Name): AMIT A SAHASRABUDHE MD PC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 E VIA DE VENTURA STE 105
SCOTTSDALE AZ
85258-3358
US

IV. Provider business mailing address

8630 E VIA DE VENTURA STE 105
SCOTTSDALE AZ
85258-3358
US

V. Phone/Fax

Practice location:
  • Phone: 480-889-1838
  • Fax: 480-889-1917
Mailing address:
  • Phone: 480-889-1838
  • Fax: 623-777-4593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number36788
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number36788
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: