MEDICARE: KENNETH LEE SANDOCK 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	174400000X	Specialist	14232	AZ
2	174400000X	Specialist	01022330A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841251733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH LEE SANDOCK M.D.

Provider Business Mailing Address
First Line	:	8311 E CRESTWOOD CIR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-2413
Country	:	US
Telephone Number	:	520-298-4677
Fax Number	:

Provider Business Practice Location Address
First Line	:	4175 S ALAMO AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85707-6097
Country	:	US
Telephone Number	:	520-228-2870
Fax Number	:

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

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	07/08/2007

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Directions to “ KENNETH LEE SANDOCK M.D.” Practice Location

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