Provider Demographics
NPI:1043237951
Name:KALYAN, SHAMLA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAMLA
Middle Name:
Last Name:KALYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 ADAMS POINTE CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4111
Mailing Address - Country:US
Mailing Address - Phone:248-212-0678
Mailing Address - Fax:248-212-0790
Practice Address - Street 1:44200 WOODWARD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5045
Practice Address - Country:US
Practice Address - Phone:248-212-0678
Practice Address - Fax:248-212-0790
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069774174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4717980-10Medicaid
MI1043237951Medicaid
MI1106366471OtherBCBS
MIH25577Medicare UPIN
MIP61030001Medicare PIN
MI1043237951Medicaid