Healthcare Provider Details

I. General information

NPI: 1841408689
Provider Name (Legal Business Name): KAMRAN SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 MCAULEY DR SUITE 6016
YPSILANTI MI
48197-1014
US

IV. Provider business mailing address

5333 MCAULEY DR SUITE 6016
YPSILANTI MI
48197-1014
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-8350
  • Fax: 775-712-8351
Mailing address:
  • Phone: 734-712-8350
  • Fax: 775-712-8351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number4301101678
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: