1700962446 NPI number — DR. SANJAY N LAKHANI MD

Table of content: DR. SANJAY N LAKHANI MD (NPI 1700962446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700962446 NPI number — DR. SANJAY N LAKHANI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAKHANI
Provider First Name:
SANJAY
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700962446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13111 WOODWARD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND PARK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48203-3781
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-866-6666
Provider Business Mailing Address Fax Number:
313-866-6661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13111 WOODWARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND PARK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48203-3781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-866-6666
Provider Business Practice Location Address Fax Number:
313-866-6661
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  4301064005 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 4301064005 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 091754 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 103425 . This is a "GREAT LAKES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4253620 . This is a "MOLINA HEALTH CARE OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5810296002 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G65330 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 001421 . This is a "MIDWEST HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G65330 . This is a "PPOM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G65330 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P94905 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 018036 . This is a "DMC CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G65330 . This is a "GREAT WEST" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104343281 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3508261242 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 49874 . This is a "OMNICARE HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 557-1 . This is a "TOTAL HEALTH CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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