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NPI Code Detail

MEDICARE: DR. MAYA SHANTIKUMAR

MEDICARE: DR. MAYA SHANTIKUMAR
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
1122300000XDentist2901019717MI

General Provider Information

NPI Number : 1538358759
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MAYA SHANTIKUMAR
Provider Business Mailing Address
First Line : 1301 ORLEANS ST
Second Line : APARTMENT 1609
City : DETROIT
State : MI
Zip : 48207-2907
Country : US
Telephone Number : 810-687-5040
Fax Number :
Provider Business Practice Location Address
First Line : 8326 N SAGINAW RD
Second Line :
City : MOUNT MORRIS
State : MI
Zip : 48458-1648
Country : US
Telephone Number : 810-687-5040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2007
Last Update Date : 10/24/2007

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Directions to “ DR. MAYA SHANTIKUMAR ” Practice Location

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