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Organization
SYLVAN LAKE FAMILY PRACTICE PLC
Active
Organization
SYLVAN LAKE FAMILY PRACTICE PLC
Active
Other names
SYLVAN LAKE FAMILY PRACTICE PLC
Organization subpart
No
Provider details
NPI number
Authorized official
PRAKASH SANGHVI M.D. (OWNER)
(248) 451-1092
Entity
Organization
Contact information
Practice address
2111 ORCHARD LAKE RD, SYLVAN LAKE, MI 48320-1785
(248) 451-1092
(248) 451-1096
Mailing address
PO BOX 673423, DETROIT, MI 48267-0001
(248) 451-1092
(248) 461-1096
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
PS066270
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0806348761
BCBS
MI
01
—
1730136961
ID NPI
MI
05
—
4743597
—
MI
01
—
G73042
UPIN
MI
Enumeration date
08/20/2006
Last updated
06/08/2021
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