Provider Demographics
NPI:1912436106
Name:SAGHER, ETHAN ABRAHAM (MD)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:ABRAHAM
Last Name:SAGHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:42452 HAYES RD STE 3
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6771
Practice Address - Country:US
Practice Address - Phone:862-633-1305
Practice Address - Fax:586-263-5183
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301112247207N00000X
MI4301503777207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology