Provider Demographics
NPI:1093765380
Name:SHAH, KARTIK H (MD)
Entity Type:Individual
Prefix:MR
First Name:KARTIK
Middle Name:H
Last Name:SHAH
Suffix:
Gender:M
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:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-0339
Mailing Address - Country:US
Mailing Address - Phone:313-381-5674
Mailing Address - Fax:313-381-7224
Practice Address - Street 1:3022 DIX HWY
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2591
Practice Address - Country:US
Practice Address - Phone:313-381-5674
Practice Address - Fax:313-381-7224
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKS039208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3275113Medicaid
MI0M27900015Medicare ID - Type Unspecified
MI3275113Medicaid