Provider Demographics
NPI:1760455513
Name:MCDADE, SARAH BETHANY (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BETHANY
Last Name:MCDADE
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 1:1405 BALMORAL DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-1442
Mailing Address - Country:US
Mailing Address - Phone:313-622-5662
Mailing Address - Fax:
Practice Address - Street 1:27209 LAHSER RD
Practice Address - Street 2:SUITE 221
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8401
Practice Address - Country:US
Practice Address - Phone:248-569-2000
Practice Address - Fax:248-569-2008
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010749052081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P50670OtherMEDICARE GROUP NUMBER
MI4933813Medicaid
MI4818400-10Medicaid
MI4925830Medicaid
MI4933804Medicaid
MI134931OtherCARE CHOICES
MI157928OtherGREAT LAKES HEALTH PLAN
MI0636250OtherBCBSM PIN
MI421720541OtherTRICARE STANDARD
MI1951791OtherUNITED HEALTHCARE
MI7526086OtherAETNA
MI1760455513Medicaid
MI612901000OtherDOL / WORKERS COMP
MI612901000OtherDOL / WORKERS COMP
MI0P50670OtherMEDICARE GROUP NUMBER