Provider Demographics
NPI:1629157094
Name:SANGHI, LALITA (MD)
Entity Type:Individual
Prefix:DR
First Name:LALITA
Middle Name:
Last Name:SANGHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6540 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2095
Mailing Address - Country:US
Mailing Address - Phone:313-381-2528
Mailing Address - Fax:313-381-3002
Practice Address - Street 1:6540 PARK AVE
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2095
Practice Address - Country:US
Practice Address - Phone:313-381-2528
Practice Address - Fax:313-381-3002
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILS034943207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE30680Medicare UPIN
08293110011Medicare ID - Type Unspecified