MEDICARE: HAMID SANJAGHSAZ DO,PC

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	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00218327	OTHER	MI	RR GROUP PIN
2	1658212014	OTHER	MI	BCBS GRP PIN

General Provider Information

NPI Number	:	1215946934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAMID SANJAGHSAZ DO,PC

Provider Business Mailing Address
First Line	:	24346 W WARREN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2234
Country	:	US
Telephone Number	:	313-563-1001
Fax Number	:	313-563-1003

Provider Business Practice Location Address
First Line	:	24346 W WARREN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2234
Country	:	US
Telephone Number	:	313-563-1001
Fax Number	:	313-563-1003

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HAMID SANJAGHSAZ
Credential	:	DO
Telephone Number	:	313-563-1001

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	08/22/2020

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