Healthcare Provider Details

I. General information

NPI: 1164462875
Provider Name (Legal Business Name): MICHAEL E SARIDAKIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EAGLE VALLEY CT STE 105
BROADVIEW HEIGHTS OH
44147-2982
US

IV. Provider business mailing address

1 EAGLE VALLEY CT STE 105
BROADVIEW HTS OH
44147-2982
US

V. Phone/Fax

Practice location:
  • Phone: 440-537-7631
  • Fax: 440-537-7631
Mailing address:
  • Phone: 440-996-5872
  • Fax: 440-970-3038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34005683
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: