Provider Demographics
NPI:1306000690
Name:SISUL, DAVID MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:SISUL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 3290
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-7290
Mailing Address - Country:US
Mailing Address - Phone:541-963-8421
Mailing Address - Fax:541-963-1476
Practice Address - Street 1:710 SUNSET DR STE F
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1200
Practice Address - Country:US
Practice Address - Phone:541-663-3100
Practice Address - Fax:541-975-5135
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2025-11-14
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Provider Licenses
StateLicense IDTaxonomies
ORMD221314208800000X
CO54022208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology