Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 084511 | MI |
NPI | 1184663627 |
---|---|
Provider Name | Jayesh R Shah |
First Address | Ann Arbor, MI 48105-1598 |
Second Address | Tecumseh, MI 49286-2018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 07/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4685027 | (05) | MI |
4718360 | (05) | MI |
A82630 | (02) | MI |
JS084511 | BC/BS (01) | MI |