Healthcare Provider Details

I. General information

NPI: 1952879199
Provider Name (Legal Business Name): SADE CHRISTINE KEYES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 WASHTENAW AVE STE 280
ANN ARBOR MI
48104-5184
US

IV. Provider business mailing address

8704 LILLY DR
YPSILANTI MI
48197-9654
US

V. Phone/Fax

Practice location:
  • Phone: 734-329-5419
  • Fax:
Mailing address:
  • Phone: 734-218-6653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601008776
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: