Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 4301045777 | MI |
NPI | 1215973086 |
---|---|
Provider Name | Dr. Rekha Sudhir Shah |
First Address | Roseville, MI 48066-3931 |
Second Address | Roseville, MI 48066-3931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4335735 | (05) | MI |