Provider Demographics
NPI:1336414101
Name:SAGE MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:SAGE MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUSBAND
Authorized Official - Prefix:
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-980-4391
Mailing Address - Street 1:3061 CHRISTY WAY
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2224
Mailing Address - Country:US
Mailing Address - Phone:989-791-2455
Mailing Address - Fax:989-791-2455
Practice Address - Street 1:6201 FOX GLEN DR
Practice Address - Street 2:APT 292
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-7352
Practice Address - Country:US
Practice Address - Phone:586-980-4391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012605207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty