Provider Demographics
NPI:1962697136
Name:BLOUGH, SARAH LEONE (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LEONE
Last Name:BLOUGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:LEONE
Other - Last Name:PICARELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2116 S MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48357-4609
Mailing Address - Country:US
Mailing Address - Phone:248-942-5888
Mailing Address - Fax:
Practice Address - Street 1:2116 S MILFORD RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357-4609
Practice Address - Country:US
Practice Address - Phone:348-942-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005150363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H231390OtherBCBSM GROUP NUMBER
MI0P47270Medicare PIN