Basic Information
| Provider Information | |||||||||
| NPI: | 1548755051 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEIR | ||||||||
| FirstName: | SARA-BETHANY | ||||||||
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| OtherLastName: | SMITH | ||||||||
| OtherFirstName: | SARA-BETHANY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 401 W GREENLAWN AVE | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489102819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179756000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1881 W GRAND RIVER AVE | ||||||||
| Address2: | |||||||||
| City: | OKEMOS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488641840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173392100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2018 | ||||||||
| LastUpdateDate: | 10/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 5101024154 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 5101025183 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.