Provider Demographics
NPI:1053391847
Name:SATER, MONA (PAC)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:SATER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:
Other - Last Name:KOBEISSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4409 GAYLORD DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4458
Mailing Address - Country:US
Mailing Address - Phone:248-225-6887
Mailing Address - Fax:248-952-1755
Practice Address - Street 1:7650 DIXIE HWY
Practice Address - Street 2:SUITE 140
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2078
Practice Address - Country:US
Practice Address - Phone:248-620-9310
Practice Address - Fax:248-620-9311
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003312363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI970030994OtherRAILROAD MEDICARE
MI970030994OtherRAILROAD MEDICARE
MIS99345Medicare UPIN
MIS99345Medicare UPIN
N37000017Medicare PIN