Healthcare Provider Details

I. General information

NPI: 1245509843
Provider Name (Legal Business Name): JOSELITO SANCHEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN
DETROIT MI
48201
US

IV. Provider business mailing address

7901 BROADWAY DEPARTMENT OF PEDIATRICS
ELMHURST NY
11373-1329
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5682
  • Fax: 313-993-8846
Mailing address:
  • Phone: 718-334-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number5301502879
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: