Healthcare Provider Details

I. General information

NPI: 1033286554
Provider Name (Legal Business Name): URVISH K SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3937 PATIENT CARE DRIVE SUITE 106
LANSING MI
48911
US

IV. Provider business mailing address

3937 PATIENT CARE DRIVE SUITE 106
LANSING MI
48911
US

V. Phone/Fax

Practice location:
  • Phone: 517-485-2317
  • Fax: 517-485-1490
Mailing address:
  • Phone: 517-485-2317
  • Fax: 517-485-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301050878
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: