Provider Demographics
NPI:1982854840
Name:SHAH, SACHIN K (MD)
Entity Type:Individual
Prefix:
First Name:SACHIN
Middle Name:K
Last Name:SHAH
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 1:1007 ALAMEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-6736
Mailing Address - Country:US
Mailing Address - Phone:773-636-9945
Mailing Address - Fax:
Practice Address - Street 1:1007 ALAMEDA BLVD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-6736
Practice Address - Country:US
Practice Address - Phone:773-636-9945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234056208000000X
MIL2357554208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics