Provider Demographics
NPI:1598095945
Name:GENERATIONS OB-GYN WEST
Entity Type:Organization
Organization Name:GENERATIONS OB-GYN WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANBORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-647-9860
Mailing Address - Street 1:17940 FARMINGTON RD
Mailing Address - Street 2:STE 230
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4444
Mailing Address - Country:US
Mailing Address - Phone:734-245-4040
Mailing Address - Fax:
Practice Address - Street 1:17940 FARMINGTON RD
Practice Address - Street 2:STE 230
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4444
Practice Address - Country:US
Practice Address - Phone:734-245-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERATIONS OB-GYN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F36482Medicare PIN