Provider Demographics
NPI:1265458947
Name:SANDIN, HOWARD NILS VICTOR
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:NILS VICTOR
Last Name:SANDIN
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 1:1625 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3768
Mailing Address - Country:US
Mailing Address - Phone:715-685-7500
Mailing Address - Fax:715-682-2481
Practice Address - Street 1:1625 MAPLE LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3768
Practice Address - Country:US
Practice Address - Phone:715-685-7500
Practice Address - Fax:715-682-2481
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20768-020207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN117819900Medicaid
WI30101400Medicaid
WI000504001Medicare PIN
B56276Medicare UPIN