MEDICARE: HASNAIN A SHAH

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	225100000X	Physical Therapist	5501301926	MI

General Provider Information

NPI Number	:	1477207512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HASNAIN A SHAH

Provider Business Mailing Address
First Line	:	590 E GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-3534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	590 E GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-3534
Country	:	US
Telephone Number	:	313-921-1580
Fax Number	:

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

Provider Enumeration Date	:	02/08/2022
Last Update Date	:	02/08/2022

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Directions to “ HASNAIN A SHAH ” Practice Location

Language	Start Address	Practice Location

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