Provider Demographics
NPI:1558645077
Name:LADIES HEALTH PLACE PC
Entity Type:Organization
Organization Name:LADIES HEALTH PLACE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SABBAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-467-4900
Mailing Address - Street 1:48641 STONERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8599
Mailing Address - Country:US
Mailing Address - Phone:734-414-0707
Mailing Address - Fax:
Practice Address - Street 1:20276 MIDDLEBELT RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2054
Practice Address - Country:US
Practice Address - Phone:248-467-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071291207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301071291OtherLICENSE NUMBER
MI4301071291OtherLICENSE NUMBER
MIMI5189001Medicare PIN