Provider Demographics
NPI:1730337478
Name:HANMOD, SANTOSH S (MD)
Entity type:Individual
Prefix:DR
First Name:SANTOSH
Middle Name:S
Last Name:HANMOD
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 1:1432 S DOBSON RD STE 107
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4769
Mailing Address - Country:US
Mailing Address - Phone:480-412-4100
Mailing Address - Fax:480-412-5154
Practice Address - Street 1:1432 S DOBSON RD STE 107
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4769
Practice Address - Country:US
Practice Address - Phone:480-412-4100
Practice Address - Fax:480-412-5154
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-06
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1242832080P0207X
MI43010922012080P0207X
AZ532502080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1730337478Medicaid
MI0C36092295Medicare PIN