Provider Demographics
NPI:1295184315
Name:SAPPHIRE PRIMARY CARE PC
Entity Type:Organization
Organization Name:SAPPHIRE PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KINAIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-999-5140
Mailing Address - Street 1:37300 DEQUINDRE RD
Mailing Address - Street 2:STE 134
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3591
Mailing Address - Country:US
Mailing Address - Phone:586-999-5140
Mailing Address - Fax:586-554-7901
Practice Address - Street 1:37300 DEQUINDRE RD
Practice Address - Street 2:STE 134
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3591
Practice Address - Country:US
Practice Address - Phone:586-999-5140
Practice Address - Fax:586-554-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301097492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty