Provider Demographics
NPI:1871578120
Name:SHEETY, MICHAEL A (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:SHEETY
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2010 E 1ST ST
Mailing Address - Street 2:STE 160
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4080
Mailing Address - Country:US
Mailing Address - Phone:714-647-1200
Mailing Address - Fax:714-647-0200
Practice Address - Street 1:1200 N TUSTIN AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3508
Practice Address - Country:US
Practice Address - Phone:714-647-1200
Practice Address - Fax:714-647-0200
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA65983174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH65213Medicare UPIN