Provider Demographics
NPI:1083671978
Name:SANDS, MICHELLE GREEN (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:GREEN
Last Name:SANDS
Suffix:
Gender:F
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:PO BOX 1000, DEPT 978
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-758-9900
Mailing Address - Fax:901-752-2335
Practice Address - Street 1:5182 SANDERLIN AVE STE 3
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4354
Practice Address - Country:US
Practice Address - Phone:901-685-0152
Practice Address - Fax:901-685-9982
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29047207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H94244Medicare UPIN
TN3889370Medicare ID - Type Unspecified
3889370Medicare ID - Type Unspecified