Provider Demographics
NPI:1023507001
Name:MICHALAK, SARAH GRACE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:GRACE
Last Name:MICHALAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:GRACE
Other - Last Name:BUSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9075 TOWN CENTRE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-4046
Mailing Address - Country:US
Mailing Address - Phone:440-526-4570
Mailing Address - Fax:440-526-4149
Practice Address - Street 1:9075 TOWN CENTRE DR STE 100
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-4046
Practice Address - Country:US
Practice Address - Phone:440-526-4570
Practice Address - Fax:440-526-4149
Is Sole Proprietor?:No
Enumeration Date:2018-05-06
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005462RX207N00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0310483Medicaid