Provider Demographics
NPI:1134388119
Name:SHEEHAN, MICHAEL P (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:SHEEHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:360 PLAZA DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2960
Mailing Address - Country:US
Mailing Address - Phone:812-376-9686
Mailing Address - Fax:812-376-9697
Practice Address - Street 1:360 PLAZA DR
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2960
Practice Address - Country:US
Practice Address - Phone:812-376-9686
Practice Address - Fax:812-376-9697
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2020-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN11013880A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100334150Medicaid
IN201059790Medicaid