Provider Demographics
NPI:1245544170
Name:LEESE, SARAH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:LEESE
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 1:5515 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-9670
Mailing Address - Country:US
Mailing Address - Phone:269-429-4002
Mailing Address - Fax:
Practice Address - Street 1:5515 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-9670
Practice Address - Country:US
Practice Address - Phone:269-429-4002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1245544170Medicaid
MI1801818752OtherBCBSM - BMG
MI1801818752OtherBCBSM - BMG