Organization
MICHIGAN PHYSICIANS GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DINESH SHAH M.D. (PRESIDENT/OWNER)
(313) 537-2107
Entity
Organization
Contact information
Practice address
2905 12 MILE RD, BERKLEY, MI 48072-1413
(248) 541-0770
(248) 541-6862
Mailing address
26105 W 6 MILE RD, REDFORD, MI 48240-2218
(313) 537-2107
(313) 537-6544
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
MI
207RC0000X
Cardiovascular Disease Physician
Primary
—
MI
2084N0400X
Neurology Physician
—
MI
213E00000X
Podiatrist
—
MI
291U00000X
Clinical Medical Laboratory
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363A00000X
Physician Assistant
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F36177
BCBSM
MI
01
—
0F38290
BCBSM LABORATORY
MI
05
—
1518041052
—
MI
01
—
6388420001
NATIONAL SUPPLIER CLEARINGHOUSE/NSC PTAN
—
Enumeration date
10/24/2006
Last updated
04/26/2012
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