Provider Demographics
NPI:1699734939
Name:SARTORI, RICHARD J (PA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:SARTORI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 W. HURON ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103
Mailing Address - Country:US
Mailing Address - Phone:734-996-8757
Mailing Address - Fax:734-996-8767
Practice Address - Street 1:706 W. HURON ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103
Practice Address - Country:US
Practice Address - Phone:734-996-8757
Practice Address - Fax:734-996-8767
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001108363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00406987Medicare PIN
MIR68510Medicare UPIN
MIM74520004Medicare PIN