Healthcare Provider Details

I. General information

NPI: 1649234980
Provider Name (Legal Business Name): PARAGON HEALTH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 W CENTRE AVE
PORTAGE MI
49024-5304
US

IV. Provider business mailing address

430 W CENTRE AVE
PORTAGE MI
49024-5304
US

V. Phone/Fax

Practice location:
  • Phone: 269-321-6673
  • Fax: 269-324-5594
Mailing address:
  • Phone: 269-321-6673
  • Fax: 269-324-5594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. SANJAY P. DALAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 269-341-4554