Provider Demographics
NPI:1164462875
Name:SARIDAKIS, MICHAEL E (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:SARIDAKIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EAGLE VALLEY CT STE 105
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-2982
Mailing Address - Country:US
Mailing Address - Phone:440-996-5872
Mailing Address - Fax:440-970-3038
Practice Address - Street 1:1 EAGLE VALLEY CT STE 105
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2982
Practice Address - Country:US
Practice Address - Phone:440-537-7631
Practice Address - Fax:440-537-7631
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000129204OtherANTHEM
OH080158099OtherRAILROAD MEDICARE
OH0247070001OtherADMINISTAR
OH110671OtherKAISER
OH2736598Medicaid
OHF77848Medicare UPIN
OHSA0759502Medicare PIN
OH000000129204OtherANTHEM
OH110671OtherKAISER