Provider Demographics
NPI:1124090675
Name:SHAH, SARJU (MD)
Entity type:Individual
Prefix:DR
First Name:SARJU
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:42287 CHERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1975
Mailing Address - Country:US
Mailing Address - Phone:734-981-1086
Mailing Address - Fax:734-981-5094
Practice Address - Street 1:15500 LUNDY PKWY
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2778
Practice Address - Country:US
Practice Address - Phone:313-586-5011
Practice Address - Fax:313-792-7134
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058742207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104521623Medicaid
P00007965OtherRAILROAD MEDICARE
0N10670003Medicare PIN
MIF80062Medicare UPIN