Provider Demographics
NPI:1043924871
Name:MICALLEF, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MICALLEF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43227 CRESCENT BLVD STE 14
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1207
Mailing Address - Country:US
Mailing Address - Phone:248-403-4475
Mailing Address - Fax:
Practice Address - Street 1:43227 CRESCENT BLVD STE 14
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1207
Practice Address - Country:US
Practice Address - Phone:248-403-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier