Basic Information
| Provider Information | |||||||||
| NPI: | 1164926754 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAGRA | ||||||||
| FirstName: | SANJANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 BANKVIEW CIRCLE | ||||||||
| Address2: | 43 BANKVIEW CIRCLE | ||||||||
| City: | TORONTO | ||||||||
| State: | ONTARIO | ||||||||
| PostalCode: | 966 | ||||||||
| CountryCode: | CA | ||||||||
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| Practice Location | |||||||||
| Address1: | 5333 MCAULEY DR RM 4001 | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481971099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347123980 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2018 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5101026029 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.