Provider Demographics
NPI:1861037335
Name:NAAMOU, SARAH DURIAH (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:DURIAH
Last Name:NAAMOU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24885 ORCHID ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-3365
Mailing Address - Country:US
Mailing Address - Phone:248-722-9168
Mailing Address - Fax:
Practice Address - Street 1:6450 MAPLE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2259
Practice Address - Country:US
Practice Address - Phone:313-216-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009518363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant