Provider Demographics
NPI:1922042183
Name:SHAH, SHOBHA L (MD)
Entity Type:Individual
Prefix:
First Name:SHOBHA
Middle Name:L
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 W HURON ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2120
Mailing Address - Country:US
Mailing Address - Phone:248-745-4900
Mailing Address - Fax:248-745-6872
Practice Address - Street 1:35 W HURON ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2120
Practice Address - Country:US
Practice Address - Phone:248-745-4900
Practice Address - Fax:248-745-6872
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010371082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG20823Medicare UPIN