Provider Demographics
NPI:1457482184
Name:SAGE, BOBBY D (DPM)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:D
Last Name:SAGE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-1526
Mailing Address - Country:US
Mailing Address - Phone:989-652-2444
Mailing Address - Fax:989-652-6066
Practice Address - Street 1:104 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1526
Practice Address - Country:US
Practice Address - Phone:989-652-2444
Practice Address - Fax:989-652-6066
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000802213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4857311200OtherBLUE CROSS BLUE SHIELD
MI4B825564OtherHEALTH PLUS
4857311200OtherBLUE CARE NETWORK OF MI
4857311200OtherBLUE CARE NETWORK OF MI
4857311200OtherBLUE CROSS BLUE SHIELD
8735003Medicare PIN