Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301067176 | MI |
N | 111NI0900X | Internist | 4301067176 | MI |
N | 207R00000X | Internist | ME98460 | FL |
N | 111NI0900X | Internist | ME98460 | FL |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | ME98460 | FL |
N | 2081P2900X | Pain Medicine | ME98460 | FL |
NPI | 1235237454 |
---|---|
Provider Name | Dr. Michael G Sandborn |
First Address | Altamonte Springs, FL 32701-6821 |
Second Address | Altamonte Springs, FL 32701-6821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 14/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009648400 | (05) | FL |
H07169 | (02) | MI |