Provider Demographics
NPI:1043219538
Name:SHETH, DHARTI (MD)
Entity Type:Individual
Prefix:DR
First Name:DHARTI
Middle Name:
Last Name:SHETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DHARTI
Other - Middle Name:SHETH
Other - Last Name:ZELMANSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:468 CADIEUX RD FL 2
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-1507
Practice Address - Country:US
Practice Address - Phone:313-473-6900
Practice Address - Fax:586-771-8901
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2310153208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4536742 10Medicaid
MIN77200002Medicare ID - Type UnspecifiedMEDICARE
MI4536742 10Medicaid