Provider Demographics
NPI:1093283608
Name:BAI, SIDA (PA)
Entity Type:Individual
Prefix:
First Name:SIDA
Middle Name:
Last Name:BAI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-3209
Mailing Address - Country:US
Mailing Address - Phone:949-395-6985
Mailing Address - Fax:
Practice Address - Street 1:509 OSBORN BLVD STE 320
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-2071
Practice Address - Country:US
Practice Address - Phone:906-632-5808
Practice Address - Fax:906-253-2639
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010244363A00000X
TXPA1323363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty