Sylvan Lake Family Practice Plc | |
2111 Orchard Lake Rd Sylvan Lake MI 48320-1785 | |
(248) 451-1092 | |
(248) 451-1096 |
Full Name | Sylvan Lake Family Practice Plc |
---|---|
Speciality | Family Medicine |
Location | 2111 Orchard Lake Rd, Sylvan Lake, Michigan |
Authorized Official Name and Position | Prakash Sanghvi (OWNER) |
Authorized Official Contact | 2484511092 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Sylvan Lake Family Practice Plc Po Box 673423 Detroit MI 48267-0001 Ph: (248) 451-1092 | Sylvan Lake Family Practice Plc 2111 Orchard Lake Rd Sylvan Lake MI 48320-1785 Ph: (248) 451-1092 |
NPI Number | 1699880989 |
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Provider Enumeration Date | 08/20/2006 |
Last Update Date | 06/08/2021 |
Medicare PECOS PAC ID | 8123056827 |
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Medicare Enrollment ID | O20050803000454 |
Identifier | Type | State | Issuer |
---|---|---|---|
1699880989 | NPI | - | NPPES |
1730136961 | Other | MI | ID NPI |
4743597 | Medicaid | MI | |
G73042 | Other | MI | UPIN |
0806348761 | Other | MI | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | PS066270 (Michigan) | Primary |
Provider Name | Prakash Nagardas Sanghvi |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1730136961 PECOS PAC ID: 2769470442 Enrollment ID: I20040503000629 |
Provider Name | Kirti P Sanghvi |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1043439219 PECOS PAC ID: 8426149279 Enrollment ID: I20070808000171 |
Provider Name | Tara Maher Elia |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1497375166 PECOS PAC ID: 4486085859 Enrollment ID: I20240401001160 |
Violet Health Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2256 Orchard Lake Rd, Sylvan Lake, MI 48320 Phone: 248-416-1499 Fax: 248-971-1132 |