Healthcare Provider Details

I. General information

NPI: 1497710982
Provider Name (Legal Business Name): SHIVA J MARALANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20952 E 12 MILE RD SUITE 200
ST CLAIR SHORES MI
48081-3200
US

IV. Provider business mailing address

20952 E 12 MILE RD SUITE 200
ST CLAIR SHORES MI
48081-3200
US

V. Phone/Fax

Practice location:
  • Phone: 586-771-4820
  • Fax: 586-771-6620
Mailing address:
  • Phone: 586-771-4820
  • Fax: 586-771-6620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number4301060368
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301060368
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: