Provider Demographics
NPI:1699859835
Name:CLAWSON INTERNIST PC
Entity Type:Organization
Organization Name:CLAWSON INTERNIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-588-4777
Mailing Address - Street 1:PO BOX 1829
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099
Mailing Address - Country:US
Mailing Address - Phone:248-588-4777
Mailing Address - Fax:248-588-1241
Practice Address - Street 1:21 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-2061
Practice Address - Country:US
Practice Address - Phone:248-588-4777
Practice Address - Fax:248-588-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067271207R00000X
MI4301057675207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110F323170OtherBCBSM
MI110F323170OtherBCBSM