Healthcare Provider Details

I. General information

NPI: 1730531146
Provider Name (Legal Business Name): SANA CHAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2016
Last Update Date: 02/07/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W NORTH ST.
JACKSON MI
49202
US

IV. Provider business mailing address

3384 OXFORD W
AUBURN HILLS MI
48326-3969
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-2555
  • Fax:
Mailing address:
  • Phone: 248-843-6917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number4351036345
License Number StateMI
# 2
Primary TaxonomyN
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: