Provider Demographics
NPI:1528085263
Name:SENAPATI, SHISHIR (MD PC)
Entity type:Individual
Prefix:
First Name:SHISHIR
Middle Name:
Last Name:SENAPATI
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43211 DALCOMA DR
Mailing Address - Street 2:#3
Mailing Address - City:CLINTON TOWNSHIP
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 TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6309
Practice Address - Country:US
Practice Address - Phone:586-263-9355
Practice Address - Fax:586-263-6835
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISS066528208D00000X
MI4301066528208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10158860001OtherWELLNESS PLAN
MI7995388OtherAETNA
MI135474OtherGLHP
MI0501580OtherBCBS
MI4800058Medicaid
MINC011918OtherMCARE
MI352243716OtherTAX ID
MIP28070088Medicare PIN
MI352243716OtherTAX ID
MI4800058Medicaid