Provider Demographics
NPI:1467459180
Name:VORA, SANJAY A (DO)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:A
Last Name:VORA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15520 19 MILE RD
Mailing Address - Street 2:SUITE 480
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6333
Mailing Address - Country:US
Mailing Address - Phone:586-228-1010
Mailing Address - Fax:586-228-8570
Practice Address - Street 1:15520 19 MILE RD
Practice Address - Street 2:SUITE 480
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6333
Practice Address - Country:US
Practice Address - Phone:586-228-1010
Practice Address - Fax:586-228-8570
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013624207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110E07884OtherBLUE CROSS/SHIELD GROUP I
MI4303384Medicaid
MI1155003035OtherBLUE CROSS/SHIELD IND PIN
MIH16182Medicare UPIN
MI4303384Medicaid