Provider Demographics
NPI:1730202599
Name:SARAGOZA, PHILIP ANDREW CORNELL (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ANDREW CORNELL
Last Name:SARAGOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2395 OAK VALLEY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9118
Mailing Address - Country:US
Mailing Address - Phone:734-995-5181
Mailing Address - Fax:734-995-9011
Practice Address - Street 1:2395 OAK VALLEY DR STE 100
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9118
Practice Address - Country:US
Practice Address - Phone:734-995-5181
Practice Address - Fax:734-995-9011
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010857252084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0942132OtherBCBS PIN