Individual
SASIKANTH NAGISETTY RAVI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
18701 N 67TH AVE, GLENDALE, AZ 85308-7100
(623) 561-1000
Mailing address
5021 N 81ST AVE, GLENDALE, AZ 85303-5505
(480) 489-0669
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R3455
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/08/2020
Last updated
07/22/2022
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