Sylvan Lake Family Practice PLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

PS066270 Issued in MI

Legal business name

SYLVAN LAKE FAMILY PRACTICE PLC

Practice address

2111 Orchard Lake Rd
Sylvan Lake, MI 48320-1785

Phone

(248) 451-1092

Fax

(248) 451-1096

NPI assigned

Aug 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Prakash Sanghvi, M.D.NPI 1730136961

Title

Owner

Phone

(248) 451-1092

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• SYLVAN LAKE FAMILY PRACTICE PLC Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Prakash N Sanghvi, M.D.

  • Family Medicine Physician
  • Sylvan Lake, MI
  • NPI 1730136961
  Medicare reassignment Care Compare group NPD Authorized official
• Kirti Prakash Sanghvi, M.D.

  • Family Medicine Physician
  • Sylvan Lake, MI
  • NPI 1043439219
  Medicare reassignment Care Compare group NPD
• Tara Maher Elia, MD

  • Family Medicine Physician
  • Bloomfield Township, MI
  • NPI 1497375166
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623110400000",
    "number": "1699880989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 673423",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482670001",
            "telephone_number": "248-451-1092",
            "fax_number": "248-461-1096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 ORCHARD LAKE RD",
            "city": "SYLVAN LAKE",
            "state": "MI",
            "postal_code": "483201785",
            "telephone_number": "248-451-1092",
            "fax_number": "248-451-1096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYLVAN LAKE FAMILY PRACTICE PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A",
        "authorized_official_last_name": "SANGHVI",
        "authorized_official_first_name": "PRAKASH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-451-1092",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "PS066270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ID NPI",
            "identifier": "1730136961",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4743597",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "G73042",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0806348761",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SYLVAN LAKE FAMILY PRACTICE PLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ronald Charles Ogusky, PH.D.
• Renaissance Health Services
• Kirti Prakash Sanghvi, M.D.
• Prakash N Sanghvi, M.D.
• Self Care Medical Equipment Inc.
• The Path to Wholeness LLC
• Violet Health PC
• Visions of Sylvan Lake
• Emilie Anne Wojcik, NP-C
• Woodward Detroit CVS, L.L.C.

• Family Medicine Physician in Sylvan Lake, MI
• Providers in Sylvan Lake, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.