Provider Demographics
NPI:1134276710
Name:SANDWEISS, YEHUDAH JAY (DO)
Entity type:Individual
Prefix:
First Name:YEHUDAH
Middle Name:JAY
Last Name:SANDWEISS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2301
Mailing Address - Country:US
Mailing Address - Phone:734-995-1880
Mailing Address - Fax:734-668-6529
Practice Address - Street 1:417 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2301
Practice Address - Country:US
Practice Address - Phone:734-995-1880
Practice Address - Fax:734-668-6529
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010343204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF10088Medicare UPIN