Healthcare Provider Details

I. General information

NPI: 1336122282
Provider Name (Legal Business Name): SARAH JO PASIA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 STONE ST SUITE 5
PORT HURON MI
48060-3569
US

IV. Provider business mailing address

1107 STONE ST SUITE 5
PORT HURON MI
48060-3569
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-9300
  • Fax: 810-985-9393
Mailing address:
  • Phone: 810-985-9300
  • Fax: 810-985-9393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101017094
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: