Provider Demographics
NPI:1942280177
Name:SHISHU, NIDHI M (MD)
Entity Type:Individual
Prefix:DR
First Name:NIDHI
Middle Name:M
Last Name:SHISHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIDHI
Other - Middle Name:DEVKINANDAN
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17392 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5438
Practice Address - Country:US
Practice Address - Phone:248-646-8166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4542786Medicaid
MI080F319020OtherBCBS