MEDICARE: MELISSA A SANDMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	4301068152	MI

General Provider Information

NPI Number	:	1821091299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA A SANDMAN MD

Provider Business Mailing Address
First Line	:	1000 E PARIS AVE SE STE 250
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3680
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 E PARIS AVE SE STE 250
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3680
Country	:	US
Telephone Number	:	616-350-9075
Fax Number	:	616-608-6814

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	12/19/2022

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