Provider Demographics
NPI:1952667081
Name:DWIVEDI, SHAMIK (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:SHAMIK
Middle Name:
Last Name:DWIVEDI
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
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Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:313-335-3444
Mailing Address - Fax:313-484-4998
Practice Address - Street 1:13210 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2704
Practice Address - Country:US
Practice Address - Phone:313-335-3444
Practice Address - Fax:313-484-4998
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019988207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease