Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 0101021297 | VA |
NPI | 1306898713 |
---|---|
Provider Name | Dr. Michael Sisk |
First Address | Roanoke, VA 24018-0612 |
Second Address | Roanoke, VA 24018-0612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 08/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006156908 | (05) | VA |
B09965 | (02) | VA |