Healthcare Provider Details

I. General information

NPI: 1609549831
Provider Name (Legal Business Name): SHAMIL KIRTESHBHAI SHETH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2021
Last Update Date: 07/25/2021
Certification Date: 07/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

1322 E MICHIGAN AVE STE 114
LANSING MI
48912-2109
US

V. Phone/Fax

Practice location:
  • Phone: 517-883-3302
  • Fax:
Mailing address:
  • Phone: 517-883-3302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4351047785
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: