Basic Information
| Provider Information | |||||||||
| NPI: | 1356349427 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SKLAR | ||||||||
| FirstName: | SANFORD | ||||||||
| MiddleName: | HOWARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29275 W 10 MILE RD | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483362817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483502722 | ||||||||
| FaxNumber: | 2483500154 | ||||||||
| Practice Location | |||||||||
| Address1: | 29275 W 10 MILE RD | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483362817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483502722 | ||||||||
| FaxNumber: | 2483500154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 08/20/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 4301047326 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 4218149 | 05 | MI | MEDICAID | 4967802 | 05 | MI | MEDICAID | CE4301 | 01 | MI | MEDICARE, RAILROAD | OTHER | 0F34972 | 01 | MI | MEDICARE CPC | OTHER | 290F349720 | 01 | MI | BLUE CROSS | OTHER |