Provider Demographics
NPI:1659395820
Name:PATEL, SANGITA C
Entity Type:Individual
Prefix:DR
First Name:SANGITA
Middle Name:C
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2888 E LONG LAKE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-7029
Mailing Address - Country:US
Mailing Address - Phone:248-250-9920
Mailing Address - Fax:248-250-9926
Practice Address - Street 1:2888 E LONG LAKE RD STE 150
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-7029
Practice Address - Country:US
Practice Address - Phone:248-250-9920
Practice Address - Fax:248-250-9926
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI089215208D00000X, 208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3524086Medicaid
MIOEO1432OtherBLUE CROSS
MI3524086Medicaid
MIMI2171001Medicare PIN