Basic Information
Provider Information
NPI: 1932362779
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SJODING
FirstName: MICHAEL
MiddleName: WILLIAM
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3621 S STATE ST
Address2: 700 KMS PLACE
City: ANN ARBOR
State: MI
PostalCode: 48108
CountryCode: US
TelephoneNumber: 7349362047
FaxNumber:  
Practice Location
Address1: 1500 E MEDICAL CENTER DRIVE
Address2: 3RD FLOOR TAUBMAN CENTER RECP C
City: ANN ARBOR
State: MI
PostalCode: 481095360
CountryCode: US
TelephoneNumber: 7346479342
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/02/2008
LastUpdateDate: 06/16/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X125054308ILN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000X4301100468MIN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RP1001X4301100468MIY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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