Provider Demographics
NPI:1407939614
Name:JACOB, SARAH S (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:S
Last Name:JACOB
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2020 MIDDLEBELT RD
Mailing Address - Street 2:GARDEN CITY MEDICAL CENTER PC
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2961
Mailing Address - Country:US
Mailing Address - Phone:734-522-3770
Mailing Address - Fax:734-522-6114
Practice Address - Street 1:2020 MIDDLEBELT RD
Practice Address - Street 2:GARDEN CITY MEDICAL CENTER PC
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2961
Practice Address - Country:US
Practice Address - Phone:734-522-3770
Practice Address - Fax:734-522-6114
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301067424208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
4301067424OtherLIC #
MI4466343Medicaid
MI383384090OtherTAXID FOR COMMERCIAL INS