Provider Demographics
NPI:1215964127
Name:SAHGAL, VIVEK S (MD, FACP)
Entity type:Individual
Prefix:
First Name:VIVEK
Middle Name:S
Last Name:SAHGAL
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 MICHIGAN AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1580
Mailing Address - Country:US
Mailing Address - Phone:574-722-4331
Mailing Address - Fax:574-722-6856
Practice Address - Street 1:1201 MICHIGAN AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1580
Practice Address - Country:US
Practice Address - Phone:574-722-4331
Practice Address - Fax:574-722-6856
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0426739207RI0200X
MO112358207RI0200X
IN01073427A207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1215964127OtherUNICARE
KS243233OtherCOVENTRY
MO25244031OtherBCBSKC
KSP00230613OtherMEDICARE RAILROAD
KS100290230DMedicaid
IN201209650Medicaid
MO209722024Medicaid
KS5188509OtherAETNA
KS104950OtherMEDICARE LEAVENWORTH INDIVIDUAL
KS104950OtherBCBSKC
MOMA1199001OtherMEDICARE
MO121596412OtherMOLINA INDIVIDUAL
INP01283806OtherRAILROAD MEDICARE
IN000000852931OtherANTHEM
KSG01527Medicare UPIN
KST117972Medicare ID - Type UnspecifiedKANSAS CITY
KS100290230DMedicaid