Provider Demographics
NPI:1508827544
Name:UPPAL, SANJAY (PT, MHS)
Entity Type:Individual
Prefix:MR
First Name:SANJAY
Middle Name:
Last Name:UPPAL
Suffix:
Gender:M
Credentials:PT, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6571 SHADOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3295
Mailing Address - Country:US
Mailing Address - Phone:248-895-1320
Mailing Address - Fax:248-945-9906
Practice Address - Street 1:26771 W 12 MILE RD
Practice Address - Street 2:SUITE # 103
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1539
Practice Address - Country:US
Practice Address - Phone:248-945-9905
Practice Address - Fax:248-945-9906
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN34280002Medicare ID - Type UnspecifiedINDIVIDUAL I.D #