Provider Demographics
NPI:1861444697
Name:MCDANIEL, SARAH (PA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1500
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48376-1500
Mailing Address - Country:US
Mailing Address - Phone:248-324-0700
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:3840 PACKARD ST
Practice Address - Street 2:STE.170
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2280
Practice Address - Country:US
Practice Address - Phone:734-975-5000
Practice Address - Fax:734-975-0376
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601003419363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP08208Medicare UPIN
MIN81780001Medicare ID - Type Unspecified