Provider Demographics
NPI:1497998926
Name:AL ANANI, SHADA (MD)
Entity Type:Individual
Prefix:
First Name:SHADA
Middle Name:
Last Name:AL ANANI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:46591 ROMEO PLANK RD STE 137
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5743
Mailing Address - Country:US
Mailing Address - Phone:313-343-6840
Mailing Address - Fax:313-343-6822
Practice Address - Street 1:22201 MOROSS RD STE 275
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2176
Practice Address - Country:US
Practice Address - Phone:313-343-6840
Practice Address - Fax:313-343-6822
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2021-04-13
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Provider Licenses
StateLicense IDTaxonomies
IL125.0544432080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology