Healthcare Provider Details

I. General information

NPI: 1831713866
Provider Name (Legal Business Name): PHILIP SAKALIAN JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11012 E 13 MILE RD STE 201
WARREN MI
48093-2547
US

IV. Provider business mailing address

11012 E 13 MILE RD STE 201
WARREN MI
48093-2547
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-6880
  • Fax:
Mailing address:
  • Phone: 586-573-6880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number5101029638
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: