Provider Demographics
NPI:1699020867
Name:SHETTY, SATVIK ASHOK (MD)
Entity Type:Individual
Prefix:
First Name:SATVIK
Middle Name:ASHOK
Last Name:SHETTY
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 1:461 W HURON ST
Mailing Address - Street 2:FAMILY MEDICINE CENTER STE 107
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1601
Mailing Address - Country:US
Mailing Address - Phone:248-857-6700
Mailing Address - Fax:248-857-6955
Practice Address - Street 1:461 W HURON ST
Practice Address - Street 2:FAMILY MEDICINE CENTER STE 107
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1601
Practice Address - Country:US
Practice Address - Phone:248-857-6700
Practice Address - Fax:248-857-6955
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101545390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program