MEDICARE: DR. ROSHNI MUKESH SHAH D.O.

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	207RC0000X	Cardiovascular Disease Physician	5101019730	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	0B510740	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1962705004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSHNI MUKESH SHAH D.O.

Provider Business Mailing Address
First Line	:	22250 PROVIDENCE DR STE 705
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-6215
Country	:	US
Telephone Number	:	248-552-9858
Fax Number	:	248-552-9510

Provider Business Practice Location Address
First Line	:	22250 PROVIDENCE DR STE 705
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-6215
Country	:	US
Telephone Number	:	248-552-9858
Fax Number	:	248-552-9510

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

Provider Enumeration Date	:	12/13/2010
Last Update Date	:	03/17/2018

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