MEDICARE: DR. PIYUSH J SHAH MD

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	208D00000X	General Practice Physician	4301033313	MI

General Provider Information

NPI Number	:	1083812457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PIYUSH J SHAH MD

Provider Business Mailing Address
First Line	:	7283 KINGSBRIDGE COURT
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-2407
Country	:	US
Telephone Number	:	734-459-0716
Fax Number	:	734-459-0716

Provider Business Practice Location Address
First Line	:	7283 KINGSBRIDGE COURT
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-2407
Country	:	US
Telephone Number	:	734-459-0716
Fax Number	:	734-459-0716

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

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	12/05/2007

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