Individual
DR. SANFORD KOLTONOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
31815 SOUTHFIELD RD STE 24, BEVERLY HILLS, MI 48025-5471
(248) 464-4354
Mailing address
31815 SOUTHFIELD RD STE 24, BEVERLY HILLS, MI 48025-5471
(248) 464-4354
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
—
—
103TP0814X
Psychoanalysis Psychologist
Primary
—
—
207P00000X
Emergency Medicine Physician
4301045596
MI
2084P0800X
Psychiatry Physician
4301045596
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010F362410
BCBSM
MI
05
—
1577750
—
MI
Enumeration date
03/23/2006
Last updated
06/14/2023
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