Basic Information
| Provider Information | |||||||||
| NPI: | 1508812488 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SONI | ||||||||
| FirstName: | PRAVIN | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2030 BIRCHWOOD WAY | ||||||||
| Address2: | |||||||||
| City: | BLOOMFIELD HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483021600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5866270024 | ||||||||
| FaxNumber: | 5866270027 | ||||||||
| Practice Location | |||||||||
| Address1: | 279 N GROESBECK HWY | ||||||||
| Address2: | |||||||||
| City: | MOUNT CLEMENS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480431546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5866270024 | ||||||||
| FaxNumber: | 5866270027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 04/21/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 1508812488 | MI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 4672851 10 | 05 | MI | MEDICAID | 4672842 10 | 05 | MI | MEDICAID |