Provider Demographics
NPI:1164492088
Name:SHAH, UPENDRA (MD)
Entity Type:Individual
Prefix:
First Name:UPENDRA
Middle Name:
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 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:12805 ESCANABA DR
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-8628
Practice Address - Country:US
Practice Address - Phone:517-367-5520
Practice Address - Fax:517-367-5521
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058499207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI160C311260OtherCOMMUNITY BLUE PPO
MI160C311260OtherBLUE CROSS BLUE SHIELD
MI160C311260OtherBLUE CHOICE
MI01795OtherAETNA
MI160C311260OtherBLUE CARE NETWORK
MIF03502OtherHEALTH NET FEDERAL SERVIC
MI4155746Medicaid
MI0700183OtherPHYSICIANS HEALTH PLAN
MI252500OtherHEALTH ADVANTAGE NETWORK
MI252500OtherMCLAREN HEALTH PLAN
MI252500OtherHEALTH ADVANTAGE NETWORK
MI252500OtherMCLAREN HEALTH PLAN