Provider Demographics
NPI:1891765798
Name:SARKODIE, AMANING (MD)
Entity Type:Individual
Prefix:
First Name:AMANING
Middle Name:
Last Name:SARKODIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5847
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-0847
Mailing Address - Country:US
Mailing Address - Phone:989-790-7670
Mailing Address - Fax:989-790-7622
Practice Address - Street 1:3444 DAVENPORT AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3306
Practice Address - Country:US
Practice Address - Phone:989-790-7670
Practice Address - Fax:989-790-7622
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4453532Medicaid
MI4858970Medicaid
MI4858970Medicaid
MI4453532Medicaid
MI0P33750Medicare PIN