Provider Demographics
NPI:1699934554
Name:MICHIGAN INFECTIOUS DISEASE CONSULTANTS PC
Entity type:Organization
Organization Name:MICHIGAN INFECTIOUS DISEASE CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KALYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-212-0678
Mailing Address - Street 1:4920 ADAMS POINTE CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4111
Mailing Address - Country:US
Mailing Address - Phone:248-212-0678
Mailing Address - Fax:248-212-0790
Practice Address - Street 1:44200 WOODWARD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5046
Practice Address - Country:US
Practice Address - Phone:248-212-0678
Practice Address - Fax:248-212-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI440F306450OtherBCS
MI1106366471OtherBCN
MI1106366471OtherBCBS
MI4717980Medicaid
MI1699934554Medicaid
MI440F306450OtherBCS
MI4717980Medicaid