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NPI Code Detail

MEDICARE: DR. TEJAL SHAH JOSEPH M.D.

MEDICARE: DR. TEJAL SHAH JOSEPH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician4301070964MI

General Provider Information

NPI Number : 1013995125
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TEJAL SHAH JOSEPH M.D.
Provider Business Mailing Address
First Line : 24 FRANK LLOYD WRIGHT DR STE J2000
Second Line :
City : ANN ARBOR
State : MI
Zip : 48105-9484
Country : US
Telephone Number : 734-747-6766
Fax Number : 734-222-3100
Provider Business Practice Location Address
First Line : 102 N. ADELAIDE STREET
Second Line :
City : FENTON
State : MI
Zip : 48430-2670
Country : US
Telephone Number : 810-629-2245
Fax Number : 810-629-6535
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2006
Last Update Date : 03/29/2021

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