Provider Demographics
NPI:1114981917
Name:BATRA, SANJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:
Last Name:BATRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22201 MOROSS ROAD
Mailing Address - Street 2:SUITE 356
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236
Mailing Address - Country:US
Mailing Address - Phone:313-343-7444
Mailing Address - Fax:313-343-7999
Practice Address - Street 1:22201 MOROSS ROAD
Practice Address - Street 2:SUITE 356
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236
Practice Address - Country:US
Practice Address - Phone:313-343-7444
Practice Address - Fax:313-343-7999
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056593208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10 3457967Medicaid
MI700E012740OtherBCBS GROUP NUMBER
0826651OtherBCBS/BCN PIN
MI0N40170Medicare PIN
G68664Medicare UPIN
OM29150 006Medicare ID - Type Unspecified