Basic Information
| Provider Information | |||||||||
| NPI: | 1932552148 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAND | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1693 FAIRGROUNDS RD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 387037810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6627252423 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1400 E UNION ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 387033246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6623783783 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2016 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 5101022621 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 207RS0012X | 27964 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
No ID Information.