Provider Demographics
NPI:1508812488
Name:SONI, PRAVIN N (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAVIN
Middle Name:N
Last Name:SONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2030 BIRCHWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1600
Mailing Address - Country:US
Mailing Address - Phone:586-627-0024
Mailing Address - Fax:586-627-0027
Practice Address - Street 1:279 N GROESBECK HWY
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-1546
Practice Address - Country:US
Practice Address - Phone:586-627-0024
Practice Address - Fax:586-627-0027
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI15088124882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4672851 10Medicaid
MI4672842 10Medicaid
N47430004Medicare PIN