Healthcare Provider Details

I. General information

NPI: 1639790108
Provider Name (Legal Business Name): ASMITA SHUKLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 JOHN R ST
DETROIT MI
48201-2013
US

IV. Provider business mailing address

PO BOX 775419
CHICAGO IL
60677-5419
US

V. Phone/Fax

Practice location:
  • Phone: 800-527-6266
  • Fax: 313-576-8627
Mailing address:
  • Phone: 586-710-8300
  • Fax: 586-710-8441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number4301516269
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: