Provider Demographics
NPI:1508948183
Name:SHUKLA, ALOK (MD)
Entity Type:Individual
Prefix:
First Name:ALOK
Middle Name:
Last Name:SHUKLA
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 1:25779 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:583-777-6231
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:583-777-6231
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI045713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1868687Medicaid
MIA76475Medicare UPIN
MI0502635Medicare ID - Type Unspecified