=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174618375
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | R BART SANGAL M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 10/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44344 DEQUINDRE RD STE 360
-----------------------------------------------------
City | STERLING HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48314-1041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-254-0707
-----------------------------------------------------
Fax | 586-254-7207
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44344 DEQUINDRE RD STE 360
-----------------------------------------------------
City | STERLING HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48314-1041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-254-0707
-----------------------------------------------------
Fax | 586-254-7207
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084S0012X
-----------------------------------------------------
Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number | 46211
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------