Provider Demographics
NPI:1568513513
Name:MICHAEL T. SHEEHAN, M.D. LLC
Entity Type:Organization
Organization Name:MICHAEL T. SHEEHAN, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTIONIER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-228-1077
Mailing Address - Street 1:750 W HIGH ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-2969
Mailing Address - Country:US
Mailing Address - Phone:419-228-1077
Mailing Address - Fax:419-228-1075
Practice Address - Street 1:750 W HIGH ST
Practice Address - Street 2:SUITE 330
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-2969
Practice Address - Country:US
Practice Address - Phone:419-228-1077
Practice Address - Fax:419-228-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.059124208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000194684OtherBLUE CROSS/BLUE SHIELD
OH0911446Medicaid
OH000000194684OtherBLUE CROSS/BLUE SHIELD
OHF51793Medicare UPIN
OH0200513513Medicare PIN