Healthcare Provider Details

I. General information

NPI: 1114900487
Provider Name (Legal Business Name): KALPANA S SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31815 SOUTHFIELD RD STE 14
BEVERLY HILLS MI
48025-5471
US

IV. Provider business mailing address

31815 SOUTHFIELD RD STE 14
BEVERLY HILLS MI
48025-5471
US

V. Phone/Fax

Practice location:
  • Phone: 248-644-5626
  • Fax: 248-644-5497
Mailing address:
  • Phone: 248-644-5626
  • Fax: 248-644-5497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301046227
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: