MEDICARE: DONNA M DESANTIS MD

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	207Q00000X	Family Medicine Physician	20867	AZ

General Provider Information

NPI Number	:	1962483727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA M DESANTIS MD

Provider Business Mailing Address
First Line	:	801 S POWER RD STE 112
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-5222
Country	:	US
Telephone Number	:	480-801-9260
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 S POWER RD STE 112
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-5222
Country	:	US
Telephone Number	:	480-801-9260
Fax Number	:

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	10/27/2022

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