Provider Demographics
NPI:1255636460
Name:SANO WOMENS HEALTH PC
Entity type:Organization
Organization Name:SANO WOMENS HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MILLARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOLUSIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-267-5040
Mailing Address - Street 1:4550 INVESTMENT DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-6363
Mailing Address - Country:US
Mailing Address - Phone:248-267-5040
Mailing Address - Fax:248-267-5041
Practice Address - Street 1:4550 INVESTMENT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6363
Practice Address - Country:US
Practice Address - Phone:248-267-5040
Practice Address - Fax:248-267-5041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMG039013207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty