MEDICARE: DR. HAMID SANJAGHSAZ D.O.

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	5101012203	MI

Other Identifiers

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

General Provider Information

NPI Number	:	1780671776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAMID SANJAGHSAZ D.O.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	10/22/2007

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