Healthcare Provider Details

I. General information

NPI: 1356369870
Provider Name (Legal Business Name): THOMAS SCOTT SANDIN P.A.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 HARBOR HILLS DR STE C
MARQUETTE MI
49855-8977
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-5458
  • Fax: 906-225-1179
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number10000475A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003375
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: