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General NPI Number Information
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NPI Number | 1114219789
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Entity Type | Individual
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Provider Name | SASI KRISHNA GHANTA MD
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Gender | Male
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Dates
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Enumeration Date | 05/13/2011
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 6950 E GOLF LINKS RD
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City | TUCSON
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State | AZ
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Zip | 85730-1017
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Country | US
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Telephone | 520-670-3909
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Fax | 520-309-3278
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Provider Business Mailing Address
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Address Line | 525S WATSON RD 200
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City | BUCKEYE
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State | AZ
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Zip | 85326-3451
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Country | US
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Telephone | 623-882-9161
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Fax | 623-925-0745
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 44088
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License Number State | AZ
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