MEDICARE: DR. SURAJ P SANCHETI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	7811	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000045475	OTHER	AL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1417930496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURAJ P SANCHETI M.D.

Provider Business Mailing Address
First Line	:	3226 RAINBOW DR
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-5805
Country	:	US
Telephone Number	:	256-442-8380
Fax Number	:	256-442-8312

Provider Business Practice Location Address
First Line	:	3226 RAINBOW DR
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-5805
Country	:	US
Telephone Number	:	256-442-8380
Fax Number	:	256-442-8312

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	12/16/2009

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