Provider Demographics
NPI:1831721679
Name:FRITCH, SARA JEAN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JEAN
Last Name:FRITCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:INBODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 LINDEN ST STE 1
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1880
Practice Address - Country:US
Practice Address - Phone:231-796-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010274363A00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315221669OtherLICENSING AND REGULATORY AFFAIRS; CONTROLLED SUBSTANCE LICENSE
MI5601010274OtherLICENSING AND REGULATORY AFFAIRS; PHYSICIAN ASSISTANT LICENSE
MIMI6186806OtherUS DEPT OF JUSTICE; DRUG ENFORCEMENT ADMINISTRATION