Provider Demographics
NPI:1073553517
Name:SAGI, PHANI SREE (MD)
Entity Type:Individual
Prefix:
First Name:PHANI
Middle Name:SREE
Last Name:SAGI
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 1:10156 E AVONDALE CIR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3283
Mailing Address - Country:US
Mailing Address - Phone:734-483-0691
Mailing Address - Fax:
Practice Address - Street 1:10156 E AVONDALE CIR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-3283
Practice Address - Country:US
Practice Address - Phone:734-483-0691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078533207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII27187Medicare UPIN