Healthcare Provider Details

I. General information

NPI: 1144460866
Provider Name (Legal Business Name): SARAH UPSHUR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2009
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 OAKWOOD BLVD
DEARBORN MI
48124-4089
US

IV. Provider business mailing address

840 OAKWOOD BLVD
DEARBORN MI
48124-2319
US

V. Phone/Fax

Practice location:
  • Phone: 313-593-7292
  • Fax: 313-436-2648
Mailing address:
  • Phone: 313-359-7680
  • Fax: 313-359-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601005458
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: