Provider Demographics
NPI:1306827647
Name:SHAH, KIRIT RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRIT
Middle Name:RAY
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:30055 NORTHWESTERN HWY
Mailing Address - Street 2:STE 220
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3230
Mailing Address - Country:US
Mailing Address - Phone:248-865-9898
Mailing Address - Fax:248-865-9423
Practice Address - Street 1:30055 NORTHWESTERN HWY
Practice Address - Street 2:STE 220
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3230
Practice Address - Country:US
Practice Address - Phone:248-865-9898
Practice Address - Fax:248-865-9423
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301039022207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3294226 10Medicaid
E26264Medicare UPIN
MIOM06660005Medicare ID - Type Unspecified