Basic Information
Provider Information
NPI: 1487772844
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GUALANO
FirstName: SARAH
MiddleName: KATHRINE
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
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OtherLastName:  
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OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3621 S STATE ST
Address2:  
City: ANN ARBOR
State: MI
PostalCode: 481081633
CountryCode: US
TelephoneNumber: 7346475299
FaxNumber:  
Practice Location
Address1: 7500 CHALLIS RD
Address2: 2ND FLOOR
City: BRIGHTON
State: MI
PostalCode: 481169416
CountryCode: US
TelephoneNumber: 8102634000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/26/2007
LastUpdateDate: 02/10/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/10/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XN3699TXN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RC0000XN3699TXN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RI0011XN3699TXN Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
207RI0011X4301086540MIN Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
207RC0000X4301086540MIY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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