Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101010763 | MI |
N | 207Q00000X | Family Doctor | HS010763 | MI |
NPI | 1508852765 |
---|---|
Provider Name | Mr. Hardik M Shah |
First Address | Detroit, MI 48224-1479 |
Second Address | Detroit, MI 48224-1479 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 10/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1285717249 | (05) | MI |
3439691 | (05) | MI |
383397259 | TAX IDENTIFICATION (01) | MI |
F45235 | (02) | MI |