Provider Demographics
NPI:1023003001
Name:SHIRDI MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SHIRDI MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIRTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AJIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-776-3180
Mailing Address - Street 1:1751 W ROMNEYA DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1815
Mailing Address - Country:US
Mailing Address - Phone:714-776-3180
Mailing Address - Fax:714-991-1932
Practice Address - Street 1:1751 W ROMNEYA DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1815
Practice Address - Country:US
Practice Address - Phone:714-776-3180
Practice Address - Fax:714-991-1932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56179207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A561790Medicaid
CA00A561790Medicaid
W14657Medicare ID - Type Unspecified