Provider Demographics
NPI:1306820378
Name:SANGEORZAN, JON A (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:A
Last Name:SANGEORZAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:560 W MITCHELL ST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2275
Mailing Address - Country:US
Mailing Address - Phone:231-487-3590
Mailing Address - Fax:231-487-3579
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:SUITE 170
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-487-3590
Practice Address - Fax:231-487-3579
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301054336207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4758150Medicaid
MIN56640006Medicare PIN