MEDICARE: SHIRIN KOUDSI

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	363A00000X	Physician Assistant	5601010857	MI

General Provider Information

NPI Number	:	1891467155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRIN KOUDSI

Provider Business Mailing Address
First Line	:	2337 HERONWOOD DR
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-0835
Country	:	US
Telephone Number	:	850-450-9788
Fax Number	:

Provider Business Practice Location Address
First Line	:	2337 HERONWOOD DR
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-0835
Country	:	US
Telephone Number	:	850-450-9788
Fax Number	:

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

Provider Enumeration Date	:	10/04/2021
Last Update Date	:	10/04/2021

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Directions to “ SHIRIN KOUDSI ” Practice Location

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