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NPI Code Detail

MEDICARE: DR. POORVI P SHAH D.O.

MEDICARE: DR. POORVI P SHAH D.O.
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
1207Q00000XFamily Medicine Physician20A7799CA
2207Q00000XFamily Medicine Physician0102202756VA
3207Q00000XFamily Medicine Physician5101027987MI

General Provider Information

NPI Number : 1306918073
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. POORVI P SHAH D.O.
Provider Business Mailing Address
First Line : 1 FORD PL STE 3A
Second Line :
City : DETROIT
State : MI
Zip : 48202-3450
Country : US
Telephone Number : 313-874-4806
Fax Number :
Provider Business Practice Location Address
First Line : 1961 S TELEGRAPH RD
Second Line :
City : BLOOMFIELD HILLS
State : MI
Zip : 48302-0246
Country : US
Telephone Number : 248-319-6190
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2006
Last Update Date : 06/06/2025

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Directions to “ DR. POORVI P SHAH D.O.” Practice Location

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