Individual
CHARLES DAVID SANDISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
79 W ALEXANDRINE ST, DETROIT, MI 48201-2015
(313) 262-0937
Mailing address
79 W ALEXANDRINE ST, DETROIT, MI 48201-2015
(313) 262-0937
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
S532115135684
MI
251S00000X
Community/Behavioral Health Agency
Primary
S532115135684
MI
Other
Enumeration date
05/10/2011
Last updated
10/30/2012
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