Basic Information
| Provider Information | |||||||||
| NPI: | 1275797946 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44250 DEQUINDRE RD | ||||||||
| Address2: | |||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483141002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489640400 | ||||||||
| FaxNumber: | 2489640401 | ||||||||
| Practice Location | |||||||||
| Address1: | 1627 W BIG BEAVER RD | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480843501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482201560 | ||||||||
| FaxNumber: | 2482201563 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2008 | ||||||||
| LastUpdateDate: | 01/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301092512 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.