Provider Demographics
NPI:1407020431
Name:TODD A SANDROCK DO PC
Entity Type:Organization
Organization Name:TODD A SANDROCK DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANDROCK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-232-6190
Mailing Address - Street 1:G3169 BEECHER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3611
Mailing Address - Country:US
Mailing Address - Phone:810-232-6190
Mailing Address - Fax:
Practice Address - Street 1:G3169 BEECHER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3611
Practice Address - Country:US
Practice Address - Phone:810-232-6190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITS012492207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2052502185OtherBLUE CROSS BLUE SHIELD MI
4577138OtherAETNA
930116191OtherRAILROAD MEDICARE
0990587OtherHEALTHPLUS OF MI
MI4304480Medicaid
930116191OtherUNITED HEALTHCARE
2052502185OtherBLUE CARE NETWORK
F45154OtherHAP
2052502185OtherBLUE CARE NETWORK
F45154OtherHAP