Provider Demographics
NPI:1952335028
Name:VIEDER, SANFORD J (DO)
Entity Type:Individual
Prefix:
First Name:SANFORD
Middle Name:J
Last Name:VIEDER
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 1:6530 BRISTOL DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3240
Mailing Address - Country:US
Mailing Address - Phone:248-931-2274
Mailing Address - Fax:248-661-9088
Practice Address - Street 1:28050 GRAND RIVER AVENUE
Practice Address - Street 2:ER DEPARTMENT
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336
Practice Address - Country:US
Practice Address - Phone:248-471-8808
Practice Address - Fax:248-615-7415
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISV010234207PE0004X
MI5101010234207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114575660Medicaid
MI114575660Medicaid
E49710Medicare UPIN