Provider Demographics
NPI:1497071617
Name:SANDLIN, MICHAEL ISIAH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ISIAH
Last Name:SANDLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 S J ST
Mailing Address - Street 2:FLOOR 4
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4930
Mailing Address - Country:US
Mailing Address - Phone:253-274-7504
Mailing Address - Fax:253-274-7994
Practice Address - Street 1:1608 S J ST
Practice Address - Street 2:FLOOR 4
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4930
Practice Address - Country:US
Practice Address - Phone:253-274-7504
Practice Address - Fax:253-274-7994
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207X00000X207X00000X
WAMD60658823207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA366551OtherSTATE L&I
WAG8957376Medicare UPIN