Provider Demographics
NPI:1336225978
Name:SAGAN-YEWAH, MARIE-LOUISE T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE-LOUISE
Middle Name:T
Last Name:SAGAN-YEWAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 775429
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5429
Mailing Address - Country:US
Mailing Address - Phone:517-975-9830
Mailing Address - Fax:517-975-9840
Practice Address - Street 1:2815 S PENNSYLVANIA AVE STE 105
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3496
Practice Address - Country:US
Practice Address - Phone:517-975-9830
Practice Address - Fax:517-975-9840
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5740111OtherFIRST HEALTH
MI080D410020OtherBCN
MI1022695OtherMCLAREN HEALTH PLAN
MIO80D410020OtherBCBS
MI1022695OtherHEALTH ADVANTAGE NETWORK
MI200000006850OtherPHYSICIANS HEALTH PLAN
MI4938195Medicaid
MII63606Medicare UPIN