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General NPI Number Information
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NPI Number | 1306918073
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Entity Type | Individual
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Provider Name | POORVI P SHAH D.O.
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Gender | Female
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 1961 S TELEGRAPH RD
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-0246
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Country | US
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Telephone | 248-319-6190
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FORD PL STE 3A
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City | DETROIT
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State | MI
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Zip | 48202-3450
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Country | US
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Telephone | 313-874-4806
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A7799
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102202756
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101027987
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License Number State | MI
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