Provider Demographics
NPI:1437227030
Name:ALOK SHUKLA ENTERPRISES PC
Entity Type:Organization
Organization Name:ALOK SHUKLA ENTERPRISES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ALOK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUKLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-777-7772
Mailing Address - Street 1:25779 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4973
Mailing Address - Country:US
Mailing Address - Phone:586-777-7772
Mailing Address - Fax:586-777-6231
Practice Address - Street 1:25779 KELLY RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4973
Practice Address - Country:US
Practice Address - Phone:586-777-7772
Practice Address - Fax:586-777-6231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI045713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1868687Medicaid
MIA76Y75Medicare UPIN
MI1868687Medicaid