Healthcare Provider Details

I. General information

NPI: 1033181482
Provider Name (Legal Business Name): SHASHIKANT NAGLE CP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21020 KELLY RD
EASTPOINTE MI
48021-3126
US

IV. Provider business mailing address

1803 HALLMARK DR
TROY MI
48098-4354
US

V. Phone/Fax

Practice location:
  • Phone: 586-777-8090
  • Fax: 586-777-9180
Mailing address:
  • Phone: 248-877-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: