Provider Demographics
NPI:1467985432
Name:ELLINGWOOD, SARA SADEGHI (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:SADEGHI
Last Name:ELLINGWOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:ASHELY
Other - Last Name:SADEGHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-647-5299
Mailing Address - Fax:
Practice Address - Street 1:380 PARKLAND PLZ
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6201
Practice Address - Country:US
Practice Address - Phone:734-647-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53760207R00000X
390200000X
MI4301504054207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1467985432Medicaid