Healthcare Provider Details

I. General information

NPI: 1801922828
Provider Name (Legal Business Name): NEAL SAKWA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 W OUTER DR
DETROIT MI
48235-2624
US

IV. Provider business mailing address

1663 W BIG BEAVER RD
TROY MI
48084-3501
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-3300
  • Fax:
Mailing address:
  • Phone: 248-816-9293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number4301047420
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: