Provider Demographics
NPI:1356540116
Name:SANDBORN, CARRIE S (DO)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:S
Last Name:SANDBORN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:S
Other - Last Name:SHEARER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:804 SERVICE RD
Mailing Address - Street 2:# A109F
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:804 SERVICE RD STE A142
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7015
Practice Address - Country:US
Practice Address - Phone:517-353-3050
Practice Address - Fax:517-432-3742
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5390211OtherBCBS