Individual
DR. SHYLAJA GONTINA-KHATIWALA
Active
Individual
DR. SHYLAJA GONTINA-KHATIWALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301076421
MI
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
4301076421
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11438804
CAQH
MI
01
—
1205836137
BCBS TYPE 1 (IND) NPI #
MI
01
—
4301076421
STATE LICENSE #
MI
01
—
5315052867
CDS #
MI
01
—
P37000001
MEDICARE IND PIN #
MI
Enumeration date
07/21/2005
Last updated
09/27/2024
Update your record
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