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General NPI Number Information
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NPI Number | 1619315728
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Entity Type | Individual
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Provider Name | SARA C FUKUZAWA PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/11/2013
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 3601 W 13 MILE RD
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City | ROYAL OAK
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State | MI
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Zip | 48073-6712
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Country | US
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Telephone | 248-898-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 7324 SOUTHWEST FWY 1550
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City | HOUSTON
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State | TX
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Zip | 77074-2053
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Country | US
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Telephone | 248-953-3706
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 5601006688
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License Number State | MI
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