Provider Demographics
NPI:1982886321
Name:MICHAEL, SARA E (PA)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:E
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:E
Other - Last Name:STOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3033 S PARKER RD
Mailing Address - Street 2:STE 800
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2910
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:3033 S PARKER RD
Practice Address - Street 2:STE 800
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2910
Practice Address - Country:US
Practice Address - Phone:303-306-7783
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2511363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12423858Medicaid
CO12423858Medicaid