Healthcare Provider Details

I. General information

NPI: 1760455513
Provider Name (Legal Business Name): SARAH BETHANY MCDADE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27209 LAHSER RD SUITE 221
SOUTHFIELD MI
48034-8401
US

IV. Provider business mailing address

1405 BALMORAL DR
DETROIT MI
48203-1442
US

V. Phone/Fax

Practice location:
  • Phone: 248-569-2000
  • Fax: 248-569-2008
Mailing address:
  • Phone: 313-622-5662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number4301074905
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: