MEDICARE: MISHA SHAIKH DDS

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
1	122300000X	Dentist	019.033293	IL

General Provider Information

NPI Number	:	1285205229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISHA SHAIKH DDS

Provider Business Mailing Address
First Line	:	3555 NORTHBROOK DR
Second Line	:
City	:	SUPERIOR TWP
State	:	MI
Zip	:	48198-8700
Country	:	US
Telephone Number	:	734-341-7980
Fax Number	:

Provider Business Practice Location Address
First Line	:	3555 NORTHBROOK DR
Second Line	:
City	:	SUPERIOR TWP
State	:	MI
Zip	:	48198-8700
Country	:	US
Telephone Number	:	734-341-7980
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	07/09/2021

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