Provider Demographics
NPI:1275972127
Name:MOLTENI, SANDRA L (DO)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:MOLTENI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20001 W 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-3403
Mailing Address - Country:US
Mailing Address - Phone:313-794-5111
Mailing Address - Fax:313-794-5153
Practice Address - Street 1:20001 W 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3403
Practice Address - Country:US
Practice Address - Phone:313-794-5111
Practice Address - Fax:313-794-5153
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63536-21207Q00000X
VT032.0133880207Q00000X
NH21790207Q00000X
MI5101027527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine