Provider Demographics
NPI:1306007695
Name:VENDITTI, SARAH ELIZABETH (MD)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ELIZABETH
Last Name:VENDITTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:KOLPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-0549
Mailing Address - Country:US
Mailing Address - Phone:906-779-9870
Mailing Address - Fax:906-779-5888
Practice Address - Street 1:1711 S STEPHENSON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3639
Practice Address - Country:US
Practice Address - Phone:906-776-5250
Practice Address - Fax:906-228-0217
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301102221207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB26002126Medicare PIN