Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 4301032767 | MI |
N | 208000000X | Pediatrician | 4301032767 | MI |
NPI | 1205851326 |
---|---|
Provider Name | Kanti Hiralal Shah |
First Address | Monroe, MI 48162-2930 |
Second Address | Monroe, MI 48162-2930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 07/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1054463 | (05) | MI |
B45448 | (02) |