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General NPI Number Information
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NPI Number | 1043266547
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Entity Type | Individual
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Provider Name | YOGESH J SHUKLA MD
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Gender | Male
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13087 E 11 MILE RD SUITE 200
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City | WARREN
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State | MI
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Zip | 48088-4782
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Country | US
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Telephone | 586-754-3060
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Fax |
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Provider Business Mailing Address
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Address Line | 2976 CHAMBORD DR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-3517
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Country | US
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Telephone | 248-626-7430
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301041529
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License Number State | MI
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