Provider Demographics
NPI:1568855690
Name:SHEETS, MICHAEL
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:SHEETS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 NE HEMBREE ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-3839
Mailing Address - Country:US
Mailing Address - Phone:971-219-7754
Mailing Address - Fax:
Practice Address - Street 1:BLOCK 6 LOT 6 DUNGENESS DRIVE
Practice Address - Street 2:
Practice Address - City:NAUKATI BAY
Practice Address - State:AK
Practice Address - Zip Code:99950
Practice Address - Country:US
Practice Address - Phone:971-219-7754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCON 38504171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor