Provider Demographics
NPI:1730136961
Name:SANGHVI, PRAKASH N (MD)
Entity Type:Individual
Prefix:
First Name:PRAKASH
Middle Name:N
Last Name:SANGHVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 673423
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0001
Mailing Address - Country:US
Mailing Address - Phone:248-857-7595
Mailing Address - Fax:248-857-7588
Practice Address - Street 1:2111 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:SYLVAN LAKE
Practice Address - State:MI
Practice Address - Zip Code:48320-1785
Practice Address - Country:US
Practice Address - Phone:248-451-1092
Practice Address - Fax:248-451-1096
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIPS066270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0806348761OtherBCBS
MI4743597Medicaid
MI4743597Medicaid
MIG73042Medicare UPIN