Healthcare Provider Details

I. General information

NPI: 1629094172
Provider Name (Legal Business Name): ROYAL OAK PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26657 WOODWARD AVE SUITE 200
HUNTINGTON WOODS MI
48070-1371
US

IV. Provider business mailing address

26657 WOODWARD AVE SUITE 200
HUNTINGTON WOODS MI
48070-1371
US

V. Phone/Fax

Practice location:
  • Phone: 248-398-8400
  • Fax: 248-398-8487
Mailing address:
  • Phone: 248-398-8400
  • Fax: 248-398-8487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LALIT J SHAH
Title or Position: MD
Credential: MD
Phone: 248-398-8400