Provider Demographics
NPI:1518018837
Name:VIVEK SAHGAL, MD, PA
Entity type:Organization
Organization Name:VIVEK SAHGAL, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-772-8630
Mailing Address - Street 1:1004 PROGRESS DR
Mailing Address - Street 2:STE 130
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-3563
Mailing Address - Country:US
Mailing Address - Phone:913-772-8630
Mailing Address - Fax:913-825-1904
Practice Address - Street 1:1004 PROGRESS DR
Practice Address - Street 2:STE 130
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043
Practice Address - Country:US
Practice Address - Phone:913-772-8630
Practice Address - Fax:913-825-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112358207RI0200X
KS04-26739207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00230613OtherMEDICARE RR
MOMA1199OtherMEDICARE - GROUP
MO209722024Medicaid
KS111180OtherMEDICARE LEAVENWORTH GROUP
KS100290230DMedicaid
MO712487OtherMOLINA
KS111180OtherMEDICARE LEAVENWORTH GROUP
KS100290230DMedicaid