Provider Demographics
NPI:1710129341
Name:SHAH, DIPAK P (MD)
Entity Type:Individual
Prefix:DR
First Name:DIPAK
Middle Name:P
Last Name:SHAH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:22250 PROVIDENCE DR
Mailing Address - Street 2:705
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4825
Mailing Address - Country:US
Mailing Address - Phone:248-552-9858
Mailing Address - Fax:248-552-9510
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:STE # 705
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-552-9858
Practice Address - Fax:248-552-9510
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2011-01-14
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Provider Licenses
StateLicense IDTaxonomies
MI4301095878207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F360210Medicare PIN