Organization
TODD A. SANDSTROM, MD, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD ALAN SANDSTROM M.D. (OWNER)
(920) 262-4412
Entity
Organization
Contact information
Practice address
123 HOSPITAL DR, SUITE 2006, WATERTOWN, WI 53098-3331
(920) 262-4412
(920) 262-4324
Mailing address
123 HOSPITAL DR, SUITE 2006, WATERTOWN, WI 53098-3331
(920) 262-4412
(920) 262-4324
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
37740
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32236700
—
WI
Enumeration date
03/01/2007
Last updated
11/02/2007
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