Provider Demographics
NPI:1164462875
Name:SARIDAKIS, MICHAEL E (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:SARIDAKIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 W AURORA RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAGAMORE HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44067-1600
Mailing Address - Country:US
Mailing Address - Phone:330-468-0437
Mailing Address - Fax:330-468-2100
Practice Address - Street 1:885 W AURORA RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SAGAMORE HILLS
Practice Address - State:OH
Practice Address - Zip Code:44067-1600
Practice Address - Country:US
Practice Address - Phone:330-468-0437
Practice Address - Fax:330-468-2100
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2736598Medicaid
OH0247070001OtherADMINISTAR
OH000000129204OtherANTHEM
OH080158099OtherRAILROAD MEDICARE
OH110671OtherKAISER
OHF77848Medicare UPIN
OHSA0759502Medicare PIN
OH000000129204OtherANTHEM
OH110671OtherKAISER