Organization
BHANU J. SHAH MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BHANU J SHAH MD (PRESIDENT)
(586) 574-2190
Entity
Organization
Contact information
Practice address
29175 RYAN RD, WARREN, MI 48092-4243
(586) 574-2190
(586) 574-2203
Mailing address
29175 RYAN RD, WARREN, MI 48092
(586) 574-2190
(586) 574-2203
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
31435
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0502020
BLUE CROSS AND BLUE SHIELD
MI
05
—
1059764
—
MI
Enumeration date
11/04/2009
Last updated
03/25/2010
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