Healthcare Provider Details

I. General information

NPI: 1710187604
Provider Name (Legal Business Name): SANA SHAMSI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 AUTO CLUB DR
DEARBORN MI
48126-2779
US

IV. Provider business mailing address

2799 W GRAND BLVD
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 313-425-4500
  • Fax: 313-425-4733
Mailing address:
  • Phone: 313-575-6317
  • Fax: 248-601-4994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301085351
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: