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General NPI Number Information
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NPI Number | 1699880989
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Entity Type | Organization
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Legal Business Name | SYLVAN LAKE FAMILY PRACTICE PLC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 2111 ORCHARD LAKE RD
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City | SYLVAN LAKE
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State | MI
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Zip | 48320-1785
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Country | US
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Telephone | 248-451-1092
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Fax | 248-451-1096
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Provider Business Mailing Address
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Address Line | PO BOX 673423
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City | DETROIT
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State | MI
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Zip | 48267-0001
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Country | US
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Telephone | 248-451-1092
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Fax | 248-461-1096
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Authorized Official
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Title or Position | OWNER
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Name | PRAKASH SANGHVI
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Credential | M.D.
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Telephone | 248-451-1092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | PS066270
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License Number State | MI
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