Provider Demographics
NPI:1932347804
Name:SHAH, AMIT ASHOKKUMAR
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:ASHOKKUMAR
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34020 7 MILE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3093
Mailing Address - Country:US
Mailing Address - Phone:248-474-8339
Mailing Address - Fax:248-474-8349
Practice Address - Street 1:34020 7 MILE RD STE 101
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3093
Practice Address - Country:US
Practice Address - Phone:248-474-8339
Practice Address - Fax:248-474-8349
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014251225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501014251OtherLICENSE NUMBER