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General NPI Number Information
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NPI Number | 1134119597
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Entity Type | Individual
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Provider Name | NIRAJ SHASHIKANT SHAH MD
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Gender | Male
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 21 S MAIN ST
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City | CLAWSON
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State | MI
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Zip | 48017-2061
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Country | US
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Telephone | 248-588-4777
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Fax | 248-588-1241
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Provider Business Mailing Address
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Address Line | PO BOX 1829
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City | TROY
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State | MI
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Zip | 48099-1829
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Country | US
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Telephone | 248-588-4777
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Fax | 248-588-1241
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | NS067271
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License Number State | MI
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