Provider Demographics
NPI:1164727525
Name:KAUL, SHAKTI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAKTI
Middle Name:
Last Name:KAUL
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 1:6480 ISLAND LAKE DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-9735
Mailing Address - Country:US
Mailing Address - Phone:517-339-2997
Mailing Address - Fax:
Practice Address - Street 1:5135 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4002
Practice Address - Country:US
Practice Address - Phone:517-887-5922
Practice Address - Fax:517-887-5982
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042095208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics