Provider Demographics
NPI:1821382862
Name:SEDORE, DEBORAH E
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:E
Last Name:SEDORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23800 W 10 MILE RD
Mailing Address - Street 2:SUITE 193
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3176
Mailing Address - Country:US
Mailing Address - Phone:248-827-1100
Mailing Address - Fax:
Practice Address - Street 1:23800 W 10 MILE RD
Practice Address - Street 2:SUITE 193
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-3176
Practice Address - Country:US
Practice Address - Phone:248-827-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501001190OtherLIC