Provider Demographics
NPI:1073563102
Name:ST. CLAIR MEDICAL P.C
Entity Type:Organization
Organization Name:ST. CLAIR MEDICAL P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SABBAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-987-1590
Mailing Address - Street 1:1209 10TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-5262
Mailing Address - Country:US
Mailing Address - Phone:810-985-8170
Mailing Address - Fax:810-985-4660
Practice Address - Street 1:1209 10TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5262
Practice Address - Country:US
Practice Address - Phone:810-985-8170
Practice Address - Fax:810-985-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G46288Medicare PIN