| Sylvan Lake Family Practice Plc | |
|
2111 Orchard Lake Rd Sylvan Lake MI 48320-1785 | |
| (248) 451-1092 | |
| (248) 451-1096 |
| Full Name | Sylvan Lake Family Practice Plc |
|---|---|
| Speciality | Family Medicine |
| Location | 2111 Orchard Lake Rd, Sylvan Lake, Michigan |
| Authorized Official Name and Position | Prakash Sanghvi (OWNER) |
| Authorized Official Contact | 2484511092 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sylvan Lake Family Practice Plc Po Box 673423 Detroit MI 48267-0001 Ph: (248) 451-1092 | Sylvan Lake Family Practice Plc 2111 Orchard Lake Rd Sylvan Lake MI 48320-1785 Ph: (248) 451-1092 |
| NPI Number | 1699880989 |
|---|---|
| Provider Enumeration Date | 08/20/2006 |
| Last Update Date | 06/08/2021 |
| Medicare PECOS PAC ID | 8123056827 |
|---|---|
| Medicare Enrollment ID | O20050803000454 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699880989 | NPI | - | NPPES |
| 1730136961 | Other | MI | ID NPI |
| 4743597 | Medicaid | MI | |
| G73042 | Other | MI | UPIN |
| 0806348761 | Other | MI | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | PS066270 (Michigan) | Primary |
| Provider Name | Prakash Nagardas Sanghvi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730136961 PECOS PAC ID: 2769470442 Enrollment ID: I20040503000629 |
| Provider Name | Kirti P Sanghvi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043439219 PECOS PAC ID: 8426149279 Enrollment ID: I20070808000171 |
Violet Health Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2266 Orchard Lake Rd, Sylvan Lake, MI 48320 Phone: 248-416-1499 Fax: 248-971-1132 |