Provider Demographics
NPI:1326096975
Name:ELMOUCHI, SARAH NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:NICOLE
Last Name:ELMOUCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 CASCADE RD SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3794
Mailing Address - Country:US
Mailing Address - Phone:616-940-3168
Mailing Address - Fax:616-940-3352
Practice Address - Street 1:5150 CASCADE RD SE
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3794
Practice Address - Country:US
Practice Address - Phone:616-940-3168
Practice Address - Fax:616-940-3352
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079696208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics