Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 20164 | MI |
Y | 213EG0000X | General Practice | 20164 | MI |
NPI | 1003129255 |
---|---|
Provider Name | Amit Shah |
First Address | Commerce Township, MI 48390-3807 |
Second Address | Commerce Township, MI 48390-3807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2010 |
Last Update Date | 16/07/2010 |