Provider Demographics
NPI:1366674673
Name:BOBICK, SARAH NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:NICOLE
Last Name:BOBICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-6000
Mailing Address - Fax:
Practice Address - Street 1:4700 MCLEOD DR E
Practice Address - Street 2:SUITE D
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2826
Practice Address - Country:US
Practice Address - Phone:989-272-0540
Practice Address - Fax:989-272-0545
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005569363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN381908328OtherHCAP
MI69222OtherHEALTH PLAN OF MICHIGAN
MI080G310660OtherBC TRADITIONAL
MI080G310660OtherBC PPO TRUST
MI1366674673OtherMOLINA HEALTHCARE OF MICHIGAN
MN381908328OtherHUMANA
MI381908328OtherHEALTHNET
MI198088OtherGREAT LAKES HEALTH PLAN OF MICHIGAN
MI080G310660OtherBC BPP
MI478OtherCARE SOURCE OF MICHIGAN
MI69222OtherHEALTH PLAN OF MICHIGAN