Healthcare Provider Details

I. General information

NPI: 1104289743
Provider Name (Legal Business Name): SHAMEL AMIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST GI DIVISION
DETROIT MI
48201-2119
US

IV. Provider business mailing address

3901 BEAUBIEN ST CARL'S BUILDING, 5TH FLOOR, GI DIVISION
DETROIT MI
48201-2196
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-7496
  • Fax: 313-993-7118
Mailing address:
  • Phone: 313-745-5585
  • Fax: 313-745-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301119326
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: