Provider Demographics
NPI:1710933932
Name:SHAH, AAJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:AAJAY
Middle Name:
Last Name:SHAH
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 1:215 E MANSION ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1559
Mailing Address - Country:US
Mailing Address - Phone:269-789-8272
Mailing Address - Fax:269-789-8273
Practice Address - Street 1:215 E MANSION ST
Practice Address - Street 2:SUITE 2F
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1559
Practice Address - Country:US
Practice Address - Phone:269-789-8272
Practice Address - Fax:269-789-8273
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055396207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200084480Medicaid
MI2500022OtherPHP OF MI
MI4673296Medicaid
IN000000792050OtherBCBS
MI0603311491OtherBCBSM PROVIDER
MI010056753OtherRAILROAD MEDICARE
MIP90592OtherBLUE CARE NETWORK
MI0331149OtherBCBS AND BCN PIN
MI4301055396OtherSTATE LICENSE
MI861085123OtherFEDERAL TAX ID
MIE82117Medicare UPIN
IN187730002Medicare PIN
MI0A37669Medicare PIN
IN000000792050OtherBCBS
MI010056753OtherRAILROAD MEDICARE