Provider Demographics
NPI:1396046439
Name:SHAIK, JAN AHMED (RPT)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:AHMED
Last Name:SHAIK
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5382 MIDCHESTER CT APT 108
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-1162
Mailing Address - Country:US
Mailing Address - Phone:248-909-5302
Mailing Address - Fax:
Practice Address - Street 1:5382 MIDCHESTER CT APT 108
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-1162
Practice Address - Country:US
Practice Address - Phone:248-909-5302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist