Healthcare Provider Details

I. General information

NPI: 1992970446
Provider Name (Legal Business Name): SHYAM N MISHRA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8202 IRVING RD SUITE 200
STERLING HTS MI
48312-4614
US

IV. Provider business mailing address

8202 IRVING RD SUITE 200
STERLING HTS MI
48312-4614
US

V. Phone/Fax

Practice location:
  • Phone: 586-268-1990
  • Fax: 586-268-1991
Mailing address:
  • Phone: 586-268-1990
  • Fax: 586-268-1991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHYAM N MISHRA
Title or Position: PRESIDENT
Credential: MD
Phone: 586-268-1990