Provider Demographics
NPI:1447516133
Name:SANGAVE, AMIT A (MD)
Entity type:Individual
Prefix:DR
First Name:AMIT
Middle Name:A
Last Name:SANGAVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19052 N R H JOHNSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4401
Mailing Address - Country:US
Mailing Address - Phone:623-474-3937
Mailing Address - Fax:623-975-7005
Practice Address - Street 1:4921 E BELL RD STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6002
Practice Address - Country:US
Practice Address - Phone:602-787-9100
Practice Address - Fax:602-787-9101
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301109274207W00000X
PAMD464124207W00000X
AZ57747207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301109274OtherLICENSE
AZ529264Medicaid
PAMD464124OtherLICENSE
AZ57747OtherLICENSE
AZ57747OtherLICENSE