Provider Demographics
NPI:1790774552
Name:MICHAELS, SARA ANN (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:MICHAELS
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:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-0160
Mailing Address - Country:US
Mailing Address - Phone:505-368-7010
Mailing Address - Fax:505-368-7011
Practice Address - Street 1:US HIGHWAY 491 N
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:505-368-7010
Practice Address - Fax:505-368-7011
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ579360Medicaid
CO22374779Medicaid
NMF1219Medicaid
H03879Medicare UPIN
8HC899Medicare PIN
AZ579360Medicaid
NMF1219Medicaid