1487689469 NPI number — MICHAEL S SHELDON MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487689469 NPI number — MICHAEL S SHELDON MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SHELDON

Provider First Name:

MICHAEL

Provider Middle Name:

S

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1487689469

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/07/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 6001

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FARGO

Provider Business Mailing Address State Name:

ND

Provider Business Mailing Address Postal Code:

58108-6001

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

701-364-3300

Provider Business Mailing Address Fax Number:

701-364-8906

Provider First Line Business Practice Location Address:

1702 UNIVERSITY DR S

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

FARGO

Provider Business Practice Location Address State Name:

ND

Provider Business Practice Location Address Postal Code:

58103-4940

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

701-364-3300

Provider Business Practice Location Address Fax Number:

701-364-8906

Provider Enumeration Date:

07/11/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  7444 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0402549 . This is a "MEDICA #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 0404040 . This is a "MEDICA #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 14064 . This is a "NDBS #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: HP22974 . This is a "HEALTHPARTNERS #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 598775 . This is a "AMERICA'S PPO/ARAZ #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 18809 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
• Identifier: 142064 . This is a "UCARE #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 15640 . This is a "SIOUX VALLEY #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: DA9011015586 . This is a "PREFERRED ONE #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: ND100011 . This is a "LHS #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 977016000 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
• Identifier: 33T91SH . This is a "MNBS #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".