Provider Demographics
NPI:1649273855
Name:DOCTOR, UMAKANT SHIVLAL (MD)
Entity type:Individual
Prefix:DR
First Name:UMAKANT
Middle Name:SHIVLAL
Last Name:DOCTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1535 GULL RD
Mailing Address - Street 2:STE 110
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1630
Mailing Address - Country:US
Mailing Address - Phone:269-276-0800
Mailing Address - Fax:269-276-0801
Practice Address - Street 1:1535 GULL RD
Practice Address - Street 2:STE 110
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1630
Practice Address - Country:US
Practice Address - Phone:269-276-0800
Practice Address - Fax:269-276-0801
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301033289207RI0011X, 207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4265944Medicaid
MI0603943711OtherBCBSM
MI4265944Medicaid
MIP47890001Medicare PIN