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General NPI Number Information
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NPI Number | 1376595272
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Entity Type | Individual
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Provider Name | RAJESH PUNJALAL SHAH MD
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 03/18/2009
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Provider Practice Location Address
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Address Line | 110 ELM ST
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City | JACKSON
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State | MI
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Zip | 49201-9108
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Country | US
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Telephone | 517-788-6760
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Fax | 517-788-3029
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Provider Business Mailing Address
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Address Line | DEPARTMENT 272801 PO BOX 67000
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City | DETROIT
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State | MI
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Zip | 48267-2728
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Country | US
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Telephone | 517-788-6760
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Fax | 517-788-3029
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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 | 4301048647
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License Number State | MI
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