Provider Demographics
NPI:1790006187
Name:BROGAN, SAPNA (MD)
Entity Type:Individual
Prefix:
First Name:SAPNA
Middle Name:
Last Name:BROGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAPNA
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:31500 TELEGRAPH RD
Mailing Address - Street 2:STE 105
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4367
Mailing Address - Country:US
Mailing Address - Phone:248-540-8700
Mailing Address - Fax:248-540-8701
Practice Address - Street 1:31500 TELEGRAPH RD
Practice Address - Street 2:STE 105
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4367
Practice Address - Country:US
Practice Address - Phone:248-540-8700
Practice Address - Fax:248-540-8701
Is Sole Proprietor?:No
Enumeration Date:2010-06-20
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125058697208000000X
MI4301102309208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1790006187Medicaid