Provider Demographics
NPI:1366811515
Name:HAYES, SARA ELIZABETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ELIZABETH
Last Name:HAYES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:ELIZABETH
Other - Last Name:GALLEMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:43451 DALCOMA DRIVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038
Mailing Address - Country:US
Mailing Address - Phone:586-286-8720
Mailing Address - Fax:586-649-6699
Practice Address - Street 1:285 N LILLEY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3907
Practice Address - Country:US
Practice Address - Phone:734-495-1506
Practice Address - Fax:734-495-1780
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007471207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM23560353Medicare PIN