Provider Demographics
NPI:1346243102
Name:SANDLIN, MICHAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:SANDLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S BELMONT AVE
Mailing Address - Street 2:STE 207
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6351
Mailing Address - Country:US
Mailing Address - Phone:918-758-0555
Mailing Address - Fax:918-758-3431
Practice Address - Street 1:1201 S BELMONT AVE
Practice Address - Street 2:STE 207
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6351
Practice Address - Country:US
Practice Address - Phone:918-758-0555
Practice Address - Fax:918-758-3431
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8971208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731152977001OtherBCBS PROVIDER NUMBER
OK100255700AMedicaid
OK731152977001OtherBCBS PROVIDER NUMBER
OK243723415Medicare PIN
OK731152977OtherEIN NUMBER
OKOK700110Medicare PIN