Healthcare Provider Details

I. General information

NPI: 1851545255
Provider Name (Legal Business Name): SARA EILEEN EADIE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13355 E 10 MILE RD
WARREN MI
48089-2048
US

IV. Provider business mailing address

7 N SQUIRREL RD
AUBURN HILLS MI
48326-4002
US

V. Phone/Fax

Practice location:
  • Phone: 586-759-7960
  • Fax:
Mailing address:
  • Phone: 248-227-2252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberAB31053220214
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: