MEDICARE: SHYAM N MISHRA MD PC

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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0508435	OTHER	MI	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992970446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHYAM N MISHRA MD PC

Provider Business Mailing Address
First Line	:	8202 IRVING RD
Second Line	:	SUITE 200
City	:	STERLING HTS
State	:	MI
Zip	:	48312-4614
Country	:	US
Telephone Number	:	586-268-1990
Fax Number	:	586-268-1991

Provider Business Practice Location Address
First Line	:	8202 IRVING RD
Second Line	:	SUITE 200
City	:	STERLING HTS
State	:	MI
Zip	:	48312-4614
Country	:	US
Telephone Number	:	586-268-1990
Fax Number	:	586-268-1991

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHYAM N MISHRA
Credential	:	MD
Telephone Number	:	586-268-1990

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	04/25/2008

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Directions to “SHYAM N MISHRA MD PC ” Practice Location

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