Healthcare Provider Details

I. General information

NPI: 1417940255
Provider Name (Legal Business Name): MICHAEL G SANGSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 CRESTWOOD RD SUITE 3
NORTH LITTLE ROCK AR
72116-7623
US

IV. Provider business mailing address

2524 CRESTWOOD RD SUITE 3
NORTH LITTLE ROCK AR
72116-7623
US

V. Phone/Fax

Practice location:
  • Phone: 501-791-7546
  • Fax: 501-753-1992
Mailing address:
  • Phone: 501-791-7546
  • Fax: 501-753-1992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC8303
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: