Healthcare Provider Details

I. General information

NPI: 1063403103
Provider Name (Legal Business Name): SANDHYA D PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31500 TELEGRAPH RD STE 105
BINGHAM FARMS MI
48025-4367
US

IV. Provider business mailing address

31500 TELEGRAPH RD STE 105
BINGHAM FARMS MI
48025-4367
US

V. Phone/Fax

Practice location:
  • Phone: 248-540-8700
  • Fax: 248-540-8701
Mailing address:
  • Phone: 248-540-8700
  • Fax: 248-540-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301067891
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: