Provider Demographics
NPI:1053369926
Name:SANABRIA, CARLOS R (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:R
Last Name:SANABRIA
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 1:525 S. SILVERBROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095
Mailing Address - Country:US
Mailing Address - Phone:262-334-6020
Mailing Address - Fax:262-334-6067
Practice Address - Street 1:525 S. SILVERBROOK DR.
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095
Practice Address - Country:US
Practice Address - Phone:262-334-6020
Practice Address - Fax:262-334-6067
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28191-20207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI005OtherBCBS
WI31684100Medicaid
P00022275Medicare PIN
WI31684100Medicaid
WI021601940Medicare PIN