Provider Demographics
NPI:1598160939
Name:AHUJA, SHAMA
Entity Type:Individual
Prefix:
First Name:SHAMA
Middle Name:
Last Name:AHUJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12459 WHITE TAIL CT
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2875
Mailing Address - Country:US
Mailing Address - Phone:734-455-4815
Mailing Address - Fax:734-455-4815
Practice Address - Street 1:12459 WHITE TAIL CT
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2875
Practice Address - Country:US
Practice Address - Phone:734-455-4815
Practice Address - Fax:734-455-4815
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040698208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics