Basic Information
| Provider Information | |||||||||
| NPI: | 1821309451 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURKETT | ||||||||
| FirstName: | SARAH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 673135 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482673135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344648300 | ||||||||
| FaxNumber: | 7344648301 | ||||||||
| Practice Location | |||||||||
| Address1: | 26850 PROVIDENCE PKWY | ||||||||
| Address2: | SUITE 375 | ||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483741213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486624200 | ||||||||
| FaxNumber: | 2486620368 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2010 | ||||||||
| LastUpdateDate: | 08/05/2013 | ||||||||
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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 | 207Q00000X | 4301097049 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4301097049 | 01 | MI | LICENSE | OTHER |