MEDICARE: DR. MICHAEL JOSEPH SISTICK OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901003598	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	110955	OTHER	EYE MED
2	900E06513	OTHER	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316060569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOSEPH SISTICK OD

Provider Business Mailing Address
First Line	:	4288 BALDWIN RD
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-1268
Country	:	US
Telephone Number	:	248-253-0900
Fax Number	:	248-332-4952

Provider Business Practice Location Address
First Line	:	4288 BALDWIN RD
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-1268
Country	:	US
Telephone Number	:	248-253-0900
Fax Number	:	248-332-4952

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	03/12/2010

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