Provider Demographics
NPI:1992992705
Name:SARDELLI, MATTHEW CARL (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CARL
Last Name:SARDELLI
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 1:5701 BOW POINTE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-5402
Mailing Address - Country:US
Mailing Address - Phone:248-792-0037
Mailing Address - Fax:
Practice Address - Street 1:5680 BOW POINTE DR STE 102
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-5407
Practice Address - Country:US
Practice Address - Phone:248-792-0037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084379207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1992992705Medicaid
MI0N45090OtherGRP MEDICARE
MI0N45090OtherGRP MEDICARE