Healthcare Provider Details

I. General information

NPI: 1710279625
Provider Name (Legal Business Name): SHIVANI SHODHAN MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 SHAFFER ST STE 1
KALAMAZOO MI
49048-1633
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 269-381-3963
  • Fax: 269-381-2809
Mailing address:
  • Phone: 269-552-2823
  • Fax: 269-552-2964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD2023-0545
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number58731
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberDR.0075449
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA136192
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301517526
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: