Individual
MRS. PRAVEENA SAMPATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1455 S LAPEER RD, SUITE 134, LAKE ORION, MI 48360-1467
(248) 683-3385
(248) 683-8441
Mailing address
2111 DORCHESTER DR N, TROY, MI 48084-3777
(248) 614-3114
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
4301077694
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301077694
STATE LICENSE
MI
Enumeration date
04/18/2007
Last updated
07/08/2007
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