Provider Demographics
NPI:1033181482
Name:NAGLE, SHASHIKANT (CP)
Entity Type:Individual
Prefix:MR
First Name:SHASHIKANT
Middle Name:
Last Name:NAGLE
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 HALLMARK DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4354
Mailing Address - Country:US
Mailing Address - Phone:248-877-8090
Mailing Address - Fax:
Practice Address - Street 1:21020 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3126
Practice Address - Country:US
Practice Address - Phone:586-777-8090
Practice Address - Fax:586-777-9180
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4186896Medicaid
MI1299610001Medicare ID - Type Unspecified