Provider Demographics
NPI:1144290446
Name:PRADHAN, SANGITA (MD)
Entity type:Individual
Prefix:
First Name:SANGITA
Middle Name:
Last Name:PRADHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 S LIVERNOIS RD STE 185
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2585
Mailing Address - Country:US
Mailing Address - Phone:248-651-1155
Mailing Address - Fax:248-651-8537
Practice Address - Street 1:441 S LIVERNOIS RD STE 185
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2585
Practice Address - Country:US
Practice Address - Phone:248-651-1155
Practice Address - Fax:248-651-8537
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISP074932207Q00000X
MI4301074932207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1108225022OtherBCBS NUMBERS
MIP01030004Medicare ID - Type UnspecifiedMEDICARE/MEDICARE GROUP
MII19454Medicare UPIN