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General NPI Number Information
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NPI Number | 1508067786
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Entity Type | Individual
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Provider Name | PRITIKA SHRIVASTAVA M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 3535 W 13 MILE RD STE 644 BEAUMONT MULTI-ORGAN TRANSPLANT CLINIC
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City | ROYAL OAK
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State | MI
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Zip | 48073-6770
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Country | US
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Telephone | 800-253-5592
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Fax | 248-551-2125
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Provider Business Mailing Address
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Address Line | 130 TOWN CENTER DR STE 203 BEAUMONT PROVIDER ENROLLMENT
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City | TROY
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State | MI
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Zip | 48084-1744
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Country | US
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Telephone | 248-585-8216
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD434606
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301101565
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MT190509
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 4301101565
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License Number State | MI
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