Healthcare Provider Details

I. General information

NPI: 1922047539
Provider Name (Legal Business Name): ANANT M SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W 5TH AVE
FLINT MI
48503-2445
US

IV. Provider business mailing address

1958 SPICEWAY DR
TROY MI
48098-4305
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-3645
  • Fax: 810-257-0760
Mailing address:
  • Phone: 248-641-9750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301064442
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: