MEDICARE: DR. UMAKANT SHIVLAL DOCTOR M.D.

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	207RI0011X	Interventional Cardiology Physician	4301033289	MI
2	207RC0000X	Cardiovascular Disease Physician	4301033289	MI
3	207UN0901X	Nuclear Cardiology Physician	4301033289	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0603943711	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1649273855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. UMAKANT SHIVLAL DOCTOR M.D.

Provider Business Mailing Address
First Line	:	1535 GULL RD
Second Line	:	STE 110
City	:	KALAMAZOO
State	:	MI
Zip	:	49048-1630
Country	:	US
Telephone Number	:	269-276-0800
Fax Number	:	269-276-0801

Provider Business Practice Location Address
First Line	:	1535 GULL RD
Second Line	:	STE 110
City	:	KALAMAZOO
State	:	MI
Zip	:	49048-1630
Country	:	US
Telephone Number	:	269-276-0800
Fax Number	:	269-276-0801

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	11/02/2007

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