Healthcare Provider Details

I. General information

NPI: 1881700706
Provider Name (Legal Business Name): UZMA SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 2ND ST
ROYAL OAK MI
48067-2694
US

IV. Provider business mailing address

110 E 2ND ST
ROYAL OAK MI
48067-2694
US

V. Phone/Fax

Practice location:
  • Phone: 248-546-2110
  • Fax: 248-607-6941
Mailing address:
  • Phone: 248-546-2110
  • Fax: 248-607-6941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number4301506526
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: