Provider Demographics
NPI:1154712073
Name:MEADOWBROOK PRIMARY CARE, PLLC
Entity type:Organization
Organization Name:MEADOWBROOK PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARJU
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-892-2712
Mailing Address - Street 1:2050 N HAGGERTY RD STE 260
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3796
Mailing Address - Country:US
Mailing Address - Phone:734-892-2712
Mailing Address - Fax:734-892-2714
Practice Address - Street 1:2050 N HAGGERTY RD STE 260
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3796
Practice Address - Country:US
Practice Address - Phone:734-892-2712
Practice Address - Fax:734-892-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty