Healthcare Provider Details

I. General information

NPI: 1538327812
Provider Name (Legal Business Name): DR. MANJIT KIRTI SHAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 STONEYBROOK COURT
WINDSOR ONTARIO
N9G2Z2
CA

IV. Provider business mailing address

1357 STONEYBROOK COURT
WINDSOR ONTARIO
N9G2Z2
CA

V. Phone/Fax

Practice location:
  • Phone: 519-984-9916
  • Fax:
Mailing address:
  • Phone: 519-984-9916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: