Provider Demographics
NPI:1962421644
Name:SHAH, JAYANT (MD)
Entity type:Individual
Prefix:
First Name:JAYANT
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:734-458-4441
Mailing Address - Fax:734-458-4432
Practice Address - Street 1:6245 INKSTER RD
Practice Address - Street 2:GARDEN CITY HOSPITAL
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-4001
Practice Address - Country:US
Practice Address - Phone:734-458-4441
Practice Address - Fax:734-458-4432
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301034421207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A79233Medicare UPIN
MI0P30630575Medicare PIN