Provider Demographics
NPI:1174697684
Name:SARAFA, GARY (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:SARAFA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25500 MEADOWBROOK RD STE 250
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1883
Mailing Address - Country:US
Mailing Address - Phone:482-773-1102
Mailing Address - Fax:888-667-3541
Practice Address - Street 1:25500 MEADOWBROOK RD STE 250
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1883
Practice Address - Country:US
Practice Address - Phone:482-773-1102
Practice Address - Fax:888-667-3541
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075307207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP35120131Medicare PIN