Provider Demographics
NPI:1215370093
Name:SGANGA, MICHAEL L (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:SGANGA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SPEEN ST
Mailing Address - Street 2:SOUTH 2-DEPARTMENT OF SURGERY
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1538
Mailing Address - Country:US
Mailing Address - Phone:508-655-0471
Mailing Address - Fax:
Practice Address - Street 1:313 SPEEN ST
Practice Address - Street 2:SOUTH 2-DEPARTMENT OF SURGERY
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1538
Practice Address - Country:US
Practice Address - Phone:508-655-0471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1308390200000X
MA2429213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program