Provider Demographics
NPI:1104139401
Name:SHAH, FAISAL MOHIUDDIN (MD)
Entity type:Individual
Prefix:
First Name:FAISAL
Middle Name:MOHIUDDIN
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34830 W 8 MILE RD
Mailing Address - Street 2:APT#103
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-5136
Mailing Address - Country:US
Mailing Address - Phone:248-736-8962
Mailing Address - Fax:
Practice Address - Street 1:34830 W 8 MILE RD
Practice Address - Street 2:APT#103
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-5136
Practice Address - Country:US
Practice Address - Phone:248-736-8962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301097222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine