Provider Demographics
NPI:1134119597
Name:SHAH, NIRAJ SHASHIKANT (MD)
Entity Type:Individual
Prefix:DR
First Name:NIRAJ
Middle Name:SHASHIKANT
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 1829
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1829
Mailing Address - Country:US
Mailing Address - Phone:248-588-4777
Mailing Address - Fax:248-588-1241
Practice Address - Street 1:21 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-2061
Practice Address - Country:US
Practice Address - Phone:248-588-4777
Practice Address - Fax:248-588-1241
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINS067271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110F323170OtherBC
G37578OtherHAP
P00032634OtherPALMETTO
383620693OtherPPOM
C6558OtherM CARE
P00032634OtherPALMETTO
G37578Medicare UPIN