Healthcare Provider Details

I. General information

NPI: 1306898713
Provider Name (Legal Business Name): MICHAEL SISK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4431 STARKEY ROAD
ROANOKE VA
24018-0612
US

IV. Provider business mailing address

4431 STARKEY ROAD
ROANOKE VA
24018-0612
US

V. Phone/Fax

Practice location:
  • Phone: 540-342-0211
  • Fax: 540-344-5543
Mailing address:
  • Phone: 540-342-0211
  • Fax: 540-344-5543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number0101021297
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: