MEDICARE: DR. KIRTI PRAKASH SANGHVI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301082762	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700F37550	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1043439219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRTI PRAKASH SANGHVI M.D.

Provider Business Mailing Address
First Line	:	2111 ORCHARD LAKE RD
Second Line	:
City	:	SYLVAN LAKE
State	:	MI
Zip	:	48320-1785
Country	:	US
Telephone Number	:	248-451-1092
Fax Number	:

Provider Business Practice Location Address
First Line	:	2111 ORCHARD LAKE RD
Second Line	:
City	:	SYLVAN LAKE
State	:	MI
Zip	:	48320-1785
Country	:	US
Telephone Number	:	248-451-1092
Fax Number	:	248-451-1096

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	06/08/2021

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