1710945043 NPI number — ASHOK R SHAH MD

Table of content: ASHOK R SHAH MD (NPI 1710945043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710945043 NPI number — ASHOK R SHAH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
ASHOK
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710945043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1560 E MAPLE RD
Provider Second Line Business Mailing Address:
SUITE 400-CREDENTIALING
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48083-1138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-993-3434
Provider Business Mailing Address Fax Number:
313-993-3421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3901 WALTER P CHRYSLER SERVICE DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-2167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-993-3434
Provider Business Practice Location Address Fax Number:
313-993-3421
Provider Enumeration Date:
05/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  4301042096 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2122648 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 260049772 . This is a "MEDICARE RR PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".