Provider Demographics
NPI:1649891664
Name:SHRIVASTAVA, ASHISH (MD)
Entity type:Individual
Prefix:
First Name:ASHISH
Middle Name:
Last Name:SHRIVASTAVA
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 1:4201 ST. ANTOINE
Mailing Address - Street 2:UHC 9C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-5146
Mailing Address - Fax:313-966-0880
Practice Address - Street 1:CHILDREN'S HOSPITAL OF MICHIGAN 3901 BEAUBIEN ST
Practice Address - Street 2:PEDIATRIC EDUCATION OFFICE 3RD FLOOR MAIN HOSPITAL 3T72
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-1892
Practice Address - Fax:313-993-7118
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program