Basic Information
| Provider Information | |||||||||
| NPI: | 1114943982 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUGARMAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24823 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981240823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254071500 | ||||||||
| FaxNumber: | 4254071112 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 SUNNYVIEW LN | ||||||||
| Address2: | |||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599013129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067525111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 05/13/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 9642 | MT | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 9642 | MT | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8409369 | 05 | WA | MEDICAID | 807035700 | 05 | ID | MEDICAID | 0043554 | 05 | MT | MEDICAID |