Provider Demographics
NPI:1285718759
Name:SHISHIR SENAPATI MD PC
Entity type:Organization
Organization Name:SHISHIR SENAPATI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHISHIR
Authorized Official - Middle Name:K
Authorized Official - Last Name:SENAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-284-9444
Mailing Address - Street 1:43211 DALCOMA DR
Mailing Address - Street 2:#3
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6309
Mailing Address - Country:US
Mailing Address - Phone:586-263-9355
Mailing Address - Fax:586-263-6835
Practice Address - Street 1:43211 DALCOMA DR
Practice Address - Street 2:#3
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6309
Practice Address - Country:US
Practice Address - Phone:586-263-9355
Practice Address - Fax:586-979-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55066528208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1105015402OtherBCBS
867733OtherCAPE HEALTH PLAN
NC011918OtherMCARE PPO
H33108OtherHAP
135474OtherGREAT LAKES
MI480005810Medicaid
7995388OtherAETNA
P00283142OtherMEDICARE TRAVELER
10158860001OtherWELLNESS PLAN
MI480005810Medicaid
7995388OtherAETNA
135474OtherGREAT LAKES