Healthcare Provider Details

I. General information

NPI: 1215626320
Provider Name (Legal Business Name): SIDRA YAKAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N SAGINAW ST
FLINT MI
48505-4452
US

IV. Provider business mailing address

29335 BATES RD
PERRYSBURG OH
43551-3810
US

V. Phone/Fax

Practice location:
  • Phone: 810-406-4246
  • Fax:
Mailing address:
  • Phone: 31-329-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: