Provider Demographics
NPI:1881729978
Name:SHAH, ATUL C (MD)
Entity type:Individual
Prefix:DR
First Name:ATUL
Middle Name:C
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8033 E. TEN MILE RD, CENTERLINE MEDICAL CLINIC
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015
Mailing Address - Country:US
Mailing Address - Phone:586-755-6101
Mailing Address - Fax:586-755-8609
Practice Address - Street 1:8033 E 10 MILE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1427
Practice Address - Country:US
Practice Address - Phone:586-755-6101
Practice Address - Fax:586-755-8609
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301053461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3402430Medicaid
MI0M47780Medicare ID - Type Unspecified
MI3402430Medicaid