Individual
DR. MICHAEL JAY SCOTT SHERIDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1116 N 16TH ST STE A, LAFAYETTE, IN 47904
(765) 448-8000
(765) 448-8807
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
01069765A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
79395
GA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
ME 87486
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000851467
ANTHEM PROVIDER NUMBER
IN
05
—
201023730
—
IN
05
—
266749500
—
FL
01
—
78677
BCBS OF FL
FL
01
—
841624482
TRICARE
FL
Enumeration date
09/22/2005
Last updated
08/10/2018
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