Provider Demographics
NPI:1821619552
Name:SHETTY, TUSHAR ANIL (MD)
Entity Type:Individual
Prefix:DR
First Name:TUSHAR
Middle Name:ANIL
Last Name:SHETTY
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 1:15 E KIRBY ST APT 721
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-4041
Mailing Address - Country:US
Mailing Address - Phone:248-224-1109
Mailing Address - Fax:
Practice Address - Street 1:4201 ST ANTOINE
Practice Address - Street 2:UHC4C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-4380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program