Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 50.005462RX | OH |
NPI | 1023507001 |
---|---|
Provider Name | Mrs. Sarah Grace Michalak |
First Address | Medina, OH 44256-8816 |
Second Address | Medina, OH 44256-8816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2018 |
Last Update Date | 31/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0310483 | (05) | OH |