MEDICARE: DR. DONALD M SANDERCOCK II DO

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	207X00000X	Orthopaedic Surgery Physician	036-121694	IL
2	207X00000X	Orthopaedic Surgery Physician	1736	TN
3	207X00000X	Orthopaedic Surgery Physician	5101013131	MI

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

General Provider Information

NPI Number	:	1891776068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD M SANDERCOCK II DO

Provider Business Mailing Address
First Line	:	401 TOWN CREEK RD E STE 101
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-5612
Country	:	US
Telephone Number	:	865-271-6160
Fax Number	:	865-374-1090

Provider Business Practice Location Address
First Line	:	401 TOWN CREEK RD E STE 101
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-5612
Country	:	US
Telephone Number	:	865-271-6160
Fax Number	:	865-374-1090

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	10/08/2025

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