MEDICARE: DR. NIDHI M SHISHU MD

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	207R00000X	Internal Medicine Physician	4301072368	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	080F319020	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1942280177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIDHI M SHISHU MD

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD STE 3D
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17392 W 13 MILE RD
Second Line	:
City	:	BEVERLY HILLS
State	:	MI
Zip	:	48025-5438
Country	:	US
Telephone Number	:	248-646-8166
Fax Number	:

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	02/10/2022

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