Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 25MA09231500 | NJ |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 4301111759 | MI |
NPI | 1083954606 |
---|---|
Provider Name | Dr. Nima M Shah |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2577 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2013 |
Last Update Date | 24/02/2021 |