Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 4301056593 | MI |
NPI | 1114981917 |
---|---|
Provider Name | Dr. Sanjay Batra |
First Address | Detroit, MI 48236 |
Second Address | Detroit, MI 48236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 23/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0826651 | BCBS/BCN PIN (01) | |
10 3457967 | (05) | MI |
700E012740 | BCBS GROUP NUMBER (01) | MI |
G68664 | (02) |