Sandra K Aldridge, PA-C

Individual provider Active NPI Medical Physician Assistant · Riverview, MI

NPI 1164513362 · NPPES record last updated Mar 7, 2023

Key facts

NPI
1164513362
Entity type
Individual (NPI type 1)
Primary specialty
Medical Physician Assistant 363AM0700X
License
5601002840 (MI)
Practice address
19020 Fort St
Riverview, MI 48193-6701
Phone
(734) 362-5100
Fax
(734) 362-5147
NPI assigned
Sep 27, 2006
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Physician Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5601002840 MI Yes

Addresses

Primary practice location

19020 Fort St
Riverview, MI 48193-6701

Mailing address

19020 Fort St
Riverview, MI 48193-6701
Phone (734) 362-5100

Other identifiers

IdentifierTypeStateIssuer
5601002840OtherMISTATE LICENSE NUMBER

Other providers in Riverview, MI

All providers in Riverview, MI · Medical Physician Assistant in Michigan

Sources for this page

Verify at the official NPI Registry.