Provider Demographics
NPI:1770554164
Name:SHRIVASTAVA, ARUNIMA (MD)
Entity type:Individual
Prefix:
First Name:ARUNIMA
Middle Name:
Last Name:SHRIVASTAVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5914 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-4322
Mailing Address - Country:US
Mailing Address - Phone:248-224-2500
Mailing Address - Fax:248-450-0888
Practice Address - Street 1:4420 E DAVISON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-1744
Practice Address - Country:US
Practice Address - Phone:313-369-1500
Practice Address - Fax:313-369-1205
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068357207QG0300X
HI22880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4478175-10Medicaid
H33280Medicare UPIN
MI4478175-10Medicaid