Active NPI
Sanford Koltonow, MD
- Psychoanalysis Psychologist
- Beverly Hills, MI
National Provider Identifier
1699734012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychoanalysis Psychologist
- Practice address
- 31815 Southfield Rd Ste 24
Beverly Hills, MI 48025-5471 - Phone
- (248) 464-4354
- NPI assigned
- Mar 23, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | |||
| Emergency Medicine Physician | 207P00000X | 4301045596 | MI | |
| Psychiatry Physician | 2084P0800X | 4301045596 | MI | |
| Psychoanalysis Psychologist | 103TP0814X | Primary |
Addresses
Primary practice location
31815 Southfield Rd Ste 24
Beverly Hills, MI 48025-5471
Mailing address
31815 Southfield Rd Ste 24
Beverly Hills, MI 48025-5471
Phone (248) 464-4354
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010F362410 | Other | MI | BCBSM |
| 1577750 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Aug 4, 2023 through Aug 4, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301045596 | MI | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686700800000",
"number": "1699734012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31815 SOUTHFIELD RD STE 24",
"city": "BEVERLY HILLS",
"state": "MI",
"postal_code": "480255471",
"telephone_number": "248-464-4354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31815 SOUTHFIELD RD STE 24",
"city": "BEVERLY HILLS",
"state": "MI",
"postal_code": "480255471",
"telephone_number": "248-464-4354"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLTONOW",
"first_name": "SANFORD",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-23",
"last_updated": "2023-06-14",
"certification_date": "2023-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": null,
"license": null,
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MI",
"license": "4301045596",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MI",
"license": "4301045596",
"primary": false
},
{
"code": "103TP0814X",
"taxonomy_group": "",
"desc": "Psychologist, Psychoanalysis",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "010F362410",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1577750",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beverly Hills, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.