Individual
SHALIMAR MOGHUL BLANTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(248) 898-5000
Mailing address
29225 SUNRIDGE, FARMINGTON HILLS, MI 48334-4012
(248) 819-6943
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704263051
MI
363L00000X
Nurse Practitioner
Primary
4704263051
MI
Other
Enumeration date
05/10/2021
Last updated
01/25/2023
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