Healthcare Provider Details

I. General information

NPI: 1073563102
Provider Name (Legal Business Name): ST. CLAIR MEDICAL P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 10TH ST SUITE E
PORT HURON MI
48060-5262
US

IV. Provider business mailing address

1209 10TH ST SUITE E
PORT HURON MI
48060-5262
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-8170
  • Fax: 810-985-4660
Mailing address:
  • Phone: 810-985-8170
  • Fax: 810-985-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: IRA SABBAGH
Title or Position: OWNER
Credential: M.D.
Phone: 810-987-1590