Healthcare Provider Details

I. General information

NPI: 1013048834
Provider Name (Legal Business Name): BOBBY D SAGE DPM & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 GENESYS PKWY
GRAND BLANC MI
48439-8070
US

IV. Provider business mailing address

3600 GENESYS PKWY
GRAND BLANC MI
48439-8070
US

V. Phone/Fax

Practice location:
  • Phone: 810-606-6950
  • Fax: 810-606-6953
Mailing address:
  • Phone: 810-606-6950
  • Fax: 810-606-6953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901000802
License Number StateMI

VIII. Authorized Official

Name: BOBBY D SAGE
Title or Position: OWNER
Credential: DPM
Phone: 810-606-6950