Provider Demographics
NPI:1497720510
Name:SHAH, GUNJAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:GUNJAN
Middle Name:P
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 1:15134 LEVAN RD
Mailing Address - Street 2:STE 34
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5027
Mailing Address - Country:US
Mailing Address - Phone:734-779-2143
Mailing Address - Fax:
Practice Address - Street 1:15134 LEVAN RD
Practice Address - Street 2:SUITE 34
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154
Practice Address - Country:US
Practice Address - Phone:734-779-2143
Practice Address - Fax:734-779-2151
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059059207RG0100X
MIG5059059174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3265959Medicaid
MI3265959Medicaid
MIOM26460Medicare ID - Type Unspecified