Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 4301083967 | MI |
Y | 207QS0010X | Family Doctor - Sports Medicine | 4301083967 | MI |
NPI | 1275743767 |
---|---|
Provider Name | Sarah Mae Bancroft-Treadway |
First Address | Traverse City, MI 49684-3294 |
Second Address | Traverse City, MI 49684-2368 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 17/08/2009 |