Healthcare Provider Details

I. General information

NPI: 1982854840
Provider Name (Legal Business Name): SACHIN K SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 ALAMEDA BLVD
TROY MI
48085-6736
US

IV. Provider business mailing address

1007 ALAMEDA BLVD
TROY MI
48085-6736
US

V. Phone/Fax

Practice location:
  • Phone: 773-636-9945
  • Fax:
Mailing address:
  • Phone: 773-636-9945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number234056
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL2357554
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: