MEDICARE: SHAMOLI KHANDERIA DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5101018559	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00471980	OTHER	IN	MEDICARE - RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043277395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAMOLI KHANDERIA DO

Provider Business Mailing Address
First Line	:	207 FLETCHER ST
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48109-1050
Country	:	US
Telephone Number	:	734-764-8320
Fax Number	:	734-763-7505

Provider Business Practice Location Address
First Line	:	207 FLETCHER ST
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48109-1050
Country	:	US
Telephone Number	:	734-764-8320
Fax Number	:	734-763-7505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	12/04/2012

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Directions to “ SHAMOLI KHANDERIA DO” Practice Location

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