Provider Demographics
NPI:1437407848
Name:SAHM, MICHAEL T (ATC/LAT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:T
Last Name:SAHM
Suffix:
Gender:M
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7840 COREY CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-5874
Mailing Address - Country:US
Mailing Address - Phone:317-374-8840
Mailing Address - Fax:
Practice Address - Street 1:3300 PRAGUE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-7010
Practice Address - Country:US
Practice Address - Phone:317-787-8277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000279A284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN36000279AOther2255A2300X-SPECIALIST/TECHNOLOGIST- ATHLETIC TRAINER