Provider Demographics
NPI:1801845839
Name:AAJAY N SHAH MD PLC
Entity Type:Organization
Organization Name:AAJAY N SHAH MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AAJAY
Authorized Official - Middle Name:N
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-214-9119
Mailing Address - Street 1:2395 JOLLY RD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864
Mailing Address - Country:US
Mailing Address - Phone:517-214-9119
Mailing Address - Fax:517-574-5957
Practice Address - Street 1:2395 JOLLY RD
Practice Address - Street 2:SUITE 145
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864
Practice Address - Country:US
Practice Address - Phone:517-214-9119
Practice Address - Fax:517-574-5957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055396174400000X, 207RC0000X
MI5601003787363AM0700X
MI5601003722363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2500022OtherPHYSICIANS HEALTH PLAN
MI010056753OtherRAILROAD MEDICARE
MI0603311491OtherBLUE CROSS BLUE SHIELD
MI4673296Medicaid
MIP90592OtherBLUE CARE NETWORK
MIN92720002Medicare ID - Type UnspecifiedPA INDIVIDUAL MEDICARE
MION92720Medicare ID - Type UnspecifiedMEDICARE PA GROUP
MION92730Medicare ID - Type UnspecifiedMEDICARE GROUP
MIN92720001Medicare ID - Type UnspecifiedPA INDIVIDUAL MEDICARE
MIE82117Medicare UPIN
MI0603311491OtherBLUE CROSS BLUE SHIELD
E82117Medicare UPIN