Provider Demographics
NPI:1306898713
Name:SISK, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SISK
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 1:4431 STARKEY ROAD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0612
Mailing Address - Country:US
Mailing Address - Phone:540-342-0211
Mailing Address - Fax:540-344-5543
Practice Address - Street 1:4431 STARKEY ROAD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0612
Practice Address - Country:US
Practice Address - Phone:540-342-0211
Practice Address - Fax:540-344-5543
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010212972084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006156908Medicaid
VA006156908Medicaid
VA131930260Medicare ID - Type Unspecified