MEDICARE: ANTHONY LEE SANDS PA-C

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	363A00000X	Physician Assistant	5601007918	MI

General Provider Information

NPI Number	:	1942757869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY LEE SANDS PA-C

Provider Business Mailing Address
First Line	:	1218 E GRAND RIVER AVE
Second Line	:
City	:	PORTLAND
State	:	MI
Zip	:	48875-1628
Country	:	US
Telephone Number	:	517-732-8877
Fax Number	:	517-659-6376

Provider Business Practice Location Address
First Line	:	1218 E GRAND RIVER AVE
Second Line	:
City	:	PORTLAND
State	:	MI
Zip	:	48875-1628
Country	:	US
Telephone Number	:	517-732-8877
Fax Number	:	517-659-6376

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

Provider Enumeration Date	:	09/08/2016
Last Update Date	:	11/09/2022

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