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General NPI Number Information
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NPI Number | 1649440231
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Entity Type | Organization
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Legal Business Name | MUKUND R SHAH MD PLC
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 3800 HOLLYWOOD RD SUITE 102
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-8510
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Country | US
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Telephone | 269-428-2727
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Fax | 269-428-0377
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Provider Business Mailing Address
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Address Line | 3800 HOLLYWOOD RD SUITE 102
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-8510
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Country | US
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Telephone | 269-428-2727
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Fax | 269-428-0377
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Authorized Official
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Title or Position | OWNER
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Name | MUKUND R SHAH
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Credential | MD
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Telephone | 269-428-2727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301039964
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License Number State | MI
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