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General NPI Number Information
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NPI Number | 1427385954
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Entity Type | Organization
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Legal Business Name | BHANU J. SHAH MD PC
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 03/25/2010
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Provider Practice Location Address
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Address Line | 29175 RYAN RD
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City | WARREN
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State | MI
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Zip | 48092-4243
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Country | US
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Telephone | 586-574-2190
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Fax | 586-574-2203
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Provider Business Mailing Address
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Address Line | 29175 RYAN RD
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City | WARREN
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State | MI
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Zip | 48092
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Country | US
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Telephone | 586-574-2190
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Fax | 586-574-2203
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BHANU J SHAH
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Credential | MD
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Telephone | 586-574-2190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 31435
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License Number State | MI
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