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General NPI Number Information
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NPI Number | 1942285663
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Entity Type | Individual
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Provider Name | TARA P SHAH MD
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Gender | Female
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 38300 VAN DYKE AVE STE 102
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City | STERLING HEIGHTS
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State | MI
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Zip | 48312-1123
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Country | US
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Telephone | 586-268-5040
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Fax | 586-268-5040
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Provider Business Mailing Address
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Address Line | 38300 VAN DYKE AVE STE 102
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City | STERLING HEIGHTS
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State | MI
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Zip | 48312-1123
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Country | US
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Telephone | 586-268-5040
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Fax | 586-268-5040
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4301036111
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License Number State | MI
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