Provider Demographics
NPI:1043439219
Name:SANGHVI, KIRTI PRAKASH (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRTI
Middle Name:PRAKASH
Last Name:SANGHVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SYLVAN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48320-1785
Mailing Address - Country:US
Mailing Address - Phone:248-451-1092
Mailing Address - Fax:
Practice Address - Street 1:2111 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:SYLVAN LAKE
Practice Address - State:MI
Practice Address - Zip Code:48320-1785
Practice Address - Country:US
Practice Address - Phone:248-451-1092
Practice Address - Fax:248-451-1096
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700F37550OtherBCBSM