Provider Demographics
NPI:1609307289
Name:GAUBATZ, SARAH JULIANN (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JULIANN
Last Name:GAUBATZ
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 1:5793 W MAPLE ROAD
Mailing Address - Street 2:STE 153
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-539-7726
Mailing Address - Fax:248-539-7823
Practice Address - Street 1:5793 W MAPLE ROAD
Practice Address - Street 2:STE 153
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-539-7726
Practice Address - Fax:248-539-7823
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.030207208000000X
390200000X
MI4301501952208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program