Provider Demographics
NPI:1831131770
Name:SHAH, ANUPAMA A (MD)
Entity Type:Individual
Prefix:
First Name:ANUPAMA
Middle Name:A
Last Name:SHAH
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 1:740 N MACOMB ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-7813
Mailing Address - Country:US
Mailing Address - Phone:734-240-5238
Mailing Address - Fax:734-240-5273
Practice Address - Street 1:740 N MACOMB ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-7813
Practice Address - Country:US
Practice Address - Phone:734-240-5238
Practice Address - Fax:734-240-5273
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064931207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3197124-10Medicaid
MIG06556Medicare UPIN
MI050039953Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MI0E86029005Medicare ID - Type Unspecified