Provider Demographics
NPI:1801891163
Name:MACKEY-SAWYER, MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:MACKEY-SAWYER
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 1:2001 E ROYALTON RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-2811
Mailing Address - Country:US
Mailing Address - Phone:440-717-6100
Mailing Address - Fax:440-546-1382
Practice Address - Street 1:2001 E ROYALTON RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2811
Practice Address - Country:US
Practice Address - Phone:440-717-6100
Practice Address - Fax:440-546-1382
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2006984Medicaid
OH2006984Medicaid
SA0818143Medicare PIN