Healthcare Provider Details

I. General information

NPI: 1467593350
Provider Name (Legal Business Name): PETRA SABALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W PATERSON ST
KALAMAZOO MI
49007-2557
US

IV. Provider business mailing address

2512 BRUCE DR
KALAMAZOO MI
49008-2263
US

V. Phone/Fax

Practice location:
  • Phone: 269-349-2641
  • Fax: 269-488-8101
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberPS060641
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: