Provider Demographics
NPI:1760003222
Name:WADNERKAR, SHIVANI PRASHANT (MD)
Entity Type:Individual
Prefix:MS
First Name:SHIVANI
Middle Name:PRASHANT
Last Name:WADNERKAR
Suffix:
Gender:F
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:DMC GME OFFICE, 4201 ST ANTOINE
Mailing Address - Street 2:UHC 9C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-5146
Mailing Address - Fax:313-966-0880
Practice Address - Street 1:CHILDRENS HOSPITAL OF MICHIGAN
Practice Address - Street 2:3901 BEAUBIEN STREET
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program