MEDICARE: MR. MICHAEL G SANGSTER 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	207N00000X	Dermatology Physician	C8303	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	070009090	OTHER	AR	RR MC
3	5594317	OTHER	AR	AETNA

General Provider Information

NPI Number	:	1417940255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL G SANGSTER MD

Provider Business Mailing Address
First Line	:	2524 CRESTWOOD RD
Second Line	:	SUITE 3
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7623
Country	:	US
Telephone Number	:	501-791-7546
Fax Number	:	501-753-1992

Provider Business Practice Location Address
First Line	:	2524 CRESTWOOD RD
Second Line	:	SUITE 3
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7623
Country	:	US
Telephone Number	:	501-791-7546
Fax Number	:	501-753-1992

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	12/15/2010

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