Provider Demographics
NPI:1548757974
Name:SARTORI, CARL JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:JOHN
Last Name:SARTORI
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 1:1851 MESQUITE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5681
Mailing Address - Country:US
Mailing Address - Phone:602-453-0094
Mailing Address - Fax:928-680-8986
Practice Address - Street 1:1851 MESQUITE AVE STE 202
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5681
Practice Address - Country:US
Practice Address - Phone:928-854-0094
Practice Address - Fax:928-680-8986
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ62333208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ096337Medicaid