Provider Demographics
NPI:1952385072
Name:SHAH, ALKA YATRIK (MD)
Entity Type:Individual
Prefix:DR
First Name:ALKA
Middle Name:YATRIK
Last Name:SHAH
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 1:2905 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1413
Mailing Address - Country:US
Mailing Address - Phone:248-541-0770
Mailing Address - Fax:248-541-6862
Practice Address - Street 1:2905 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1413
Practice Address - Country:US
Practice Address - Phone:248-541-0770
Practice Address - Fax:248-541-6862
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD250252084N0400X
MI43010664692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104086273Medicaid
MI104086273Medicaid
F14226Medicare UPIN