Healthcare Provider Details

I. General information

NPI: 1801862248
Provider Name (Legal Business Name): NANCY SABAL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2006
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 BIDDLE AVE STE 2
WYANDOTTE MI
48192-4080
US

IV. Provider business mailing address

23050 WEST RD SUITE 130 ATTN DENISE GOMOLL
BROWNSTOWN MI
48193-1473
US

V. Phone/Fax

Practice location:
  • Phone: 734-671-6741
  • Fax: 734-671-1038
Mailing address:
  • Phone: 734-671-1404
  • Fax: 734-391-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101010371
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: