Provider Demographics
NPI:1356349427
Name:SKLAR, SANFORD HOWARD (MD)
Entity type:Individual
Prefix:
First Name:SANFORD
Middle Name:HOWARD
Last Name:SKLAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29275 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2817
Mailing Address - Country:US
Mailing Address - Phone:248-350-2722
Mailing Address - Fax:248-350-0154
Practice Address - Street 1:29275 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2817
Practice Address - Country:US
Practice Address - Phone:248-350-2722
Practice Address - Fax:248-350-0154
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047326207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4218149Medicaid
MI4967802Medicaid
MICE4301OtherMEDICARE, RAILROAD
MI0F34972OtherMEDICARE CPC
MI290F349720OtherBLUE CROSS
MICE4301OtherMEDICARE, RAILROAD
MI00115080Medicare ID - Type Unspecified
MI0F34972OtherMEDICARE CPC