Healthcare Provider Details

I. General information

NPI: 1629206784
Provider Name (Legal Business Name): SARAH BETH POPLAWSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N. EAST AVENUE EMERGENCY DEPARTMENT
JACKSON MI
49201
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-4811
  • Fax: 517-796-6410
Mailing address:
  • Phone: 313-874-4806
  • Fax: 313-876-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005517
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: