Healthcare Provider Details

I. General information

NPI: 1245232990
Provider Name (Legal Business Name): RICHARD SANCHEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16489 GLENEAGLES CT
NOBLESVILLE IN
46060-7182
US

IV. Provider business mailing address

16489 GLENEAGLES CT
NOBLESVILLE IN
46060-7182
US

V. Phone/Fax

Practice location:
  • Phone: 219-669-0111
  • Fax:
Mailing address:
  • Phone: 219-669-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number2016-01711
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01051929A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: