Healthcare Provider Details

I. General information

NPI: 1013079813
Provider Name (Legal Business Name): BRUCE ANTHONY SADILEK N.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7468 N LA CHOLLA BLVD
TUCSON AZ
85741-2306
US

IV. Provider business mailing address

7468 N LA CHOLLA BLVD
TUCSON AZ
85741-2306
US

V. Phone/Fax

Practice location:
  • Phone: 520-297-9664
  • Fax: 520-297-9633
Mailing address:
  • Phone: 520-297-9664
  • Fax: 520-297-9633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number97513
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number97-513
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: