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General NPI Number Information
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NPI Number | 1871958744
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Entity Type | Individual
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Provider Name | SABA MADHOUN PA
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Gender | Female
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Dates
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Enumeration Date | 12/21/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 15150 FORT ST
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City | SOUTHGATE
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State | MI
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Zip | 48195-1302
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Country | US
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Telephone | 734-282-4800
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Fax | 734-282-9302
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Provider Business Mailing Address
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Address Line | 15150 FORT
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City | SOUTHGATE
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State | MI
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Zip | 48195
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Country | US
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Telephone | 734-282-4800
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Fax | 734-282-9302
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601008284
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License Number State | MI
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