Healthcare Provider Details

I. General information

NPI: 1053429464
Provider Name (Legal Business Name): JAMES SANSONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 W ANN ARBOR TRL SUITE 210
PLYMOUTH MI
48170-6204
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR PO BOX 0446 LOBBY J
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 734-455-4600
  • Fax: 734-455-5637
Mailing address:
  • Phone: 734-747-6766
  • Fax: 734-222-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301051576
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: