Provider Demographics
NPI:1992970446
Name:SHYAM N MISHRA MD PC
Entity type:Organization
Organization Name:SHYAM N MISHRA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHYAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:MISHRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-268-1990
Mailing Address - Street 1:8202 IRVING RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-4614
Mailing Address - Country:US
Mailing Address - Phone:586-268-1990
Mailing Address - Fax:586-268-1991
Practice Address - Street 1:8202 IRVING RD
Practice Address - Street 2:SUITE 200
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48312-4614
Practice Address - Country:US
Practice Address - Phone:586-268-1990
Practice Address - Fax:586-268-1991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0508435OtherBCBS
MI1079453 10Medicaid