MEDICARE: DR. NIRAJ SHASHIKANT 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	207R00000X	Internal Medicine Physician	NS067271	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	110F323170	OTHER	BC
2	G37578	OTHER	HAP
3	P00032634	OTHER	PALMETTO
4	383620693	OTHER	PPOM
5	C6558	OTHER	M CARE

General Provider Information

NPI Number	:	1134119597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIRAJ SHASHIKANT SHAH MD

Provider Business Mailing Address
First Line	:	PO BOX 1829
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48099-1829
Country	:	US
Telephone Number	:	248-588-4777
Fax Number	:	248-588-1241

Provider Business Practice Location Address
First Line	:	21 S MAIN ST
Second Line	:
City	:	CLAWSON
State	:	MI
Zip	:	48017-2061
Country	:	US
Telephone Number	:	248-588-4777
Fax Number	:	248-588-1241

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	10/08/2010

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Directions to “ DR. NIRAJ SHASHIKANT SHAH MD” Practice Location

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