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Individual
SARA CUSTODIO
Active
Individual
SARA CUSTODIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301085859
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C910950
BCBSM
MI
05
—
1417162173
—
MI
Enumeration date
05/14/2007
Last updated
11/27/2023
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