1285685503 NPI number — SARA H GARMEL MD

Table of content: SARA H GARMEL MD (NPI 1285685503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285685503 NPI number — SARA H GARMEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARMEL
Provider First Name:
SARA
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285685503
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2142 MONROE ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEARBORN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48124-3057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-481-1030
Provider Business Mailing Address Fax Number:
313-481-1031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2142 MONROE ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48124-3057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-481-1030
Provider Business Practice Location Address Fax Number:
313-481-1031
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VM0101X , with the licence number:  SG071022 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4944620 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: SG071022 . This is a "LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104944620 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: F70638 . This is a "UPIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4252007 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 160H229520 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 364509477 . This is a "TAX ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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