Healthcare Provider Details

I. General information

NPI: 1184008633
Provider Name (Legal Business Name): JAIMIE ALEXANDRA SAWASKY M.S. PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD
DETROIT MI
48202-2608
US

IV. Provider business mailing address

42621 GARFIELD RD. SUITE 108
CHARTER TOWNSHIP OF CLINTON MI
48038
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2181
  • Fax:
Mailing address:
  • Phone: 586-263-3312
  • Fax: 586-263-5311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007410
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: