Provider Demographics
NPI:1275832784
Name:DENHAM, SARAH JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:JEAN
Last Name:DENHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3955 PATIENT CARE WAY STE A
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4271
Mailing Address - Country:US
Mailing Address - Phone:517-374-7600
Mailing Address - Fax:517-374-1126
Practice Address - Street 1:1003 E MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910
Practice Address - Country:US
Practice Address - Phone:517-853-3704
Practice Address - Fax:517-853-3701
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1275832784Medicaid
MI5330636OtherBCBS PIN
MI200000046525OtherPHP
MI1275832784Medicaid