Healthcare Provider Details

I. General information

NPI: 1548757701
Provider Name (Legal Business Name): SANKET DIPCHANDBHAI PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MEDICAL CENTER DR
CARLETON MI
48117-9461
US

IV. Provider business mailing address

111 MEDICAL CENTER DR
CARLETON MI
48117-9461
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-8580
  • Fax: 734-240-4789
Mailing address:
  • Phone: 734-240-8580
  • Fax: 734-240-4789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301503238
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: