MEDICARE: DR. SANDRA C ROLAND M.D.

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	2085R0202X	Diagnostic Radiology Physician	01062856A	IN
2	2085R0204X	Vascular & Interventional Radiology Physician	101028	WI
3	2085R0204X	Vascular & Interventional Radiology Physician	036097741	IL
4	2085R0204X	Vascular & Interventional Radiology Physician	01062856A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1102429111	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659321545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA C ROLAND M.D.

Provider Business Mailing Address
First Line	:	5215 HOLY CROSS PKWY
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-1469
Country	:	US
Telephone Number	:	574-335-8707
Fax Number	:	574-335-0741

Provider Business Practice Location Address
First Line	:	611 E DOUGLAS RD STE 200
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-1465
Country	:	US
Telephone Number	:	574-335-6850
Fax Number	:	574-335-0849

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	04/10/2025

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Directions to “ DR. SANDRA C ROLAND M.D.” Practice Location

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