Provider Demographics
NPI:1396296836
Name:SANDRIDGE, MICHAEL LEE (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:SANDRIDGE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8687 E VIA DE VENTURA
Mailing Address - Street 2:STE 318
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3351
Mailing Address - Country:US
Mailing Address - Phone:480-905-8755
Mailing Address - Fax:480-905-8851
Practice Address - Street 1:8687 E VIA DE VENTURA
Practice Address - Street 2:SUITE 318
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3347
Practice Address - Country:US
Practice Address - Phone:480-905-8755
Practice Address - Fax:480-905-8851
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ6577363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant