Provider Demographics
NPI:1700962446
Name:LAKHANI, SANJAY N (MD)
Entity type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:N
Last Name:LAKHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13111 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3781
Mailing Address - Country:US
Mailing Address - Phone:313-866-6666
Mailing Address - Fax:313-866-6661
Practice Address - Street 1:13111 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3781
Practice Address - Country:US
Practice Address - Phone:313-866-6666
Practice Address - Fax:313-866-6661
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064005208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI091754OtherAETNA
MI103425OtherGREAT LAKES HEALTH PLAN
MI4253620OtherMOLINA HEALTH CARE OF MI
MI5810296002OtherCIGNA
MIG65330OtherUNITED HEALTH CARE
MI001421OtherMIDWEST HEALTH PLAN
MIG65330OtherPPOM
MIG65330OtherHEALTH ALLIANCE PLAN
MIP94905OtherBLUE CARE NETWORK
MI018036OtherDMC CARE
MIG65330OtherGREAT WEST
MI104343281Medicaid
MI3508261242OtherBCBSM
MI49874OtherOMNICARE HEALTH PLAN
MI557-1OtherTOTAL HEALTH CARE
MI103425OtherGREAT LAKES HEALTH PLAN
MI4253620OtherMOLINA HEALTH CARE OF MI
MI0N36120Medicare PIN