Provider Demographics
NPI:1164454211
Name:SARIBALAS, MICHAEL GEORGE
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GEORGE
Last Name:SARIBALAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4449 EASTON WAY FL 2
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-7005
Mailing Address - Country:US
Mailing Address - Phone:614-532-5232
Mailing Address - Fax:866-554-1848
Practice Address - Street 1:4449 EASTON WAY FL 2
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-7005
Practice Address - Country:US
Practice Address - Phone:614-532-5232
Practice Address - Fax:866-554-1848
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN368372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN138325600Medicaid
260002010Medicare ID - Type Unspecified
MN138325600Medicaid