Healthcare Provider Details

I. General information

NPI: 1801845839
Provider Name (Legal Business Name): AAJAY N SHAH MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2395 JOLLY RD SUITE 145
OKEMOS MI
48864
US

IV. Provider business mailing address

2395 JOLLY RD SUITE 145
OKEMOS MI
48864
US

V. Phone/Fax

Practice location:
  • Phone: 517-214-9119
  • Fax: 517-574-5957
Mailing address:
  • Phone: 517-214-9119
  • Fax: 517-574-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301055396
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301055396
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601003787
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601003722
License Number StateMI

VIII. Authorized Official

Name: DR. AAJAY N SHAH
Title or Position: OWNER
Credential: MD
Phone: 517-214-9119