MEDICARE: PRAKASH N 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	PS066270	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0806348761	OTHER	MI	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730136961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRAKASH N SANGHVI M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 673423
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48267-0001
Country	:	US
Telephone Number	:	248-857-7595
Fax Number	:	248-857-7588

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	:	05/31/2006
Last Update Date	:	06/08/2021

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