Healthcare Provider Details

I. General information

NPI: 1730167800
Provider Name (Legal Business Name): JEFFREY ALAN SENDI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42669 GARFIELD RD EMERGENCY MEDICINE DEPARTMENT
CLINTON TWP MI
48038-5036
US

IV. Provider business mailing address

6549 TOWN CENTER DR CREDENTIALING/PAYER CONTRACTING SERVICES
CLARKSTON MI
48346-4824
US

V. Phone/Fax

Practice location:
  • Phone: 586-412-5321
  • Fax: 586-412-5327
Mailing address:
  • Phone: 248-620-6400
  • Fax: 248-620-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101013688
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101011688
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0102202280
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: