Healthcare Provider Details

I. General information

NPI: 1073809935
Provider Name (Legal Business Name): KATHERINE J SAGE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1195 WILSON AVE NW STE 200
GRAND RAPIDS MI
49534-6405
US

IV. Provider business mailing address

5175 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-1048
US

V. Phone/Fax

Practice location:
  • Phone: 616-453-8277
  • Fax: 616-453-2002
Mailing address:
  • Phone: 616-453-0294
  • Fax: 616-726-1492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101019357
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: