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1407850134

NPI Code Detail

MEDICARE: MICHAEL A SARIDAKIS MD

MEDICARE: MICHAEL A SARIDAKIS MD

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	208600000X	Surgery Physician	29430	TN
2	208600000X	Surgery Physician	48331	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K130430	OTHER	KY	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407850134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL A SARIDAKIS MD

Provider Business Mailing Address
First Line	:	310 N L ROGERS WELLS BLVD
Second Line	:
City	:	GLASGOW
State	:	KY
Zip	:	42141-1300
Country	:	US
Telephone Number	:	270-659-5945
Fax Number	:	270-659-5855

Provider Business Practice Location Address
First Line	:	310 N L ROGERS WELLS BLVD STE 103
Second Line	:
City	:	GLASGOW
State	:	KY
Zip	:	42141-1300
Country	:	US
Telephone Number	:	270-659-5945
Fax Number	:	270-659-5855

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	04/24/2023

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Directions to “ MICHAEL A SARIDAKIS MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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