Provider Demographics
NPI:1235131541
Name:SANDROCK, TODD A (DO)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:SANDROCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7383
Mailing Address - Country:US
Mailing Address - Phone:810-232-6190
Mailing Address - Fax:810-232-9348
Practice Address - Street 1:861 HEALTH PARK BLVD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439
Practice Address - Country:US
Practice Address - Phone:810-953-0500
Practice Address - Fax:810-953-0031
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MITS012492207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383602347OtherCHAMPUS/TRICARE
MI0990587OtherHEALTHPLUS OF MICHIGAN
MIF45154OtherHEALTH ALLIANCE PLAN
MI131822OtherCARE CHOICES
MI4304480Medicaid
MI930116191OtherMEDICARE RAILROAD
MIC7778OtherMCARE
MIP104439OtherBLUECARE NETWORK
MI383602347OtherPPOM
MIF45154OtherSELECTCARE
MI20-5250218-5OtherBLUE CROSS OF MICHIGAN
MI4577138OtherAETNA
MIC7778OtherMCARE
MI4304480Medicaid
MIF45154Medicare UPIN