Provider Demographics
NPI:1801307871
Name:NIDHI SHISHU
Entity type:Organization
Organization Name:NIDHI SHISHU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIDHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHISHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-840-8289
Mailing Address - Street 1:4521 RIVER TRL
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3642
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4521 RIVER TRL
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48301-3642
Practice Address - Country:US
Practice Address - Phone:248-840-8289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty