MEDICARE: DR. PHILIP ANDREW CORNELL SARAGOZA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084F0202X	Forensic Psychiatry Physician	4301085725	MI
2	2084P0800X	Psychiatry Physician	4301085725	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0942132	OTHER	MI	BCBS PIN

General Provider Information

NPI Number	:	1730202599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP ANDREW CORNELL SARAGOZA M.D.

Provider Business Mailing Address
First Line	:	2395 OAK VALLEY DR STE 100
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-9118
Country	:	US
Telephone Number	:	734-995-5181
Fax Number	:	734-995-9011

Provider Business Practice Location Address
First Line	:	2395 OAK VALLEY DR STE 100
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-9118
Country	:	US
Telephone Number	:	734-995-5181
Fax Number	:	734-995-9011

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	02/10/2016

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