Provider Demographics
NPI:1295743896
Name:SHAH, BHANU J (MD)
Entity type:Individual
Prefix:MRS
First Name:BHANU
Middle Name:J
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:37300 DEQUINDRE RD STE 115
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3508
Mailing Address - Country:US
Mailing Address - Phone:586-574-2190
Mailing Address - Fax:586-574-2203
Practice Address - Street 1:37300 DEQUINDRE RD STE 115
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310
Practice Address - Country:US
Practice Address - Phone:586-574-2190
Practice Address - Fax:586-574-2203
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2019-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI31534207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI105976410Medicaid
MIE39769Medicare UPIN
MI105976410Medicaid