Basic Information
Provider Information
NPI: 1265896609
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SEHGAL
FirstName: LAKSHYA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 FORD PL STE 3A
Address2:  
City: DETROIT
State: MI
PostalCode: 482023450
CountryCode: US
TelephoneNumber: 3138744806
FaxNumber:  
Practice Location
Address1: 2799 W GRAND BLVD
Address2:  
City: DETROIT
State: MI
PostalCode: 482022608
CountryCode: US
TelephoneNumber: 8006536568
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/12/2016
LastUpdateDate: 06/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085B0100XMD474397PAN Allopathic & Osteopathic PhysiciansRadiologyBody Imaging
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
2085R0202X4301506566MIY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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