Healthcare Provider Details

I. General information

NPI: 1396850418
Provider Name (Legal Business Name): SANFORD MEDICAL CENTER P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 E SAGINAW RD UNIT 4
SANFORD MI
48657-9293
US

IV. Provider business mailing address

3061 CHRISTY WAY
SAGINAW MI
48603-2267
US

V. Phone/Fax

Practice location:
  • Phone: 989-687-7812
  • Fax: 989-687-7813
Mailing address:
  • Phone: 989-791-2455
  • Fax: 989-791-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HICHAM CHURBAJI
Title or Position: PRESIDENT
Credential: MD
Phone: 989-687-7812