Healthcare Provider Details

I. General information

NPI: 1104609759
Provider Name (Legal Business Name): LAURIE ELLYN SABIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27774 FRANKLIN RD
SOUTHFIELD MI
48034-2352
US

IV. Provider business mailing address

5373 VAN NESS CT
BLOOMFIELD HILLS MI
48302-2659
US

V. Phone/Fax

Practice location:
  • Phone: 248-356-5555
  • Fax:
Mailing address:
  • Phone: 248-245-9517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101013322
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: