Healthcare Provider Details

I. General information

NPI: 1437054400
Provider Name (Legal Business Name): SPARKSMD FAMILY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 LEXINGTON GREEN LN
SANFORD FL
32771-1005
US

IV. Provider business mailing address

920 LEXINGTON GREEN LN
SANFORD FL
32771-1005
US

V. Phone/Fax

Practice location:
  • Phone: 407-392-1058
  • Fax: 407-392-1053
Mailing address:
  • Phone: 407-392-1058
  • Fax: 407-392-1053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MICHAEL SPARKS
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 407-392-1058