Individual
RIDDHI JAY SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3901 STONEGATE PARK, SUITE 300, SAINT JOSEPH, MI 49085-9137
(269) 408-4265
(269) 556-6020
Mailing address
3901 STONEGATE PARK, SUITE 300, SAINT JOSEPH, MI 49085-9137
(269) 408-4265
(269) 556-6020
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
5101020760
MI
208D00000X
General Practice Physician
58.004442
OH
363A00000X
Physician Assistant
C0003431
MD
363AS0400X
Surgical Physician Assistant
011440
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568504397
—
MI
Enumeration date
02/12/2007
Last updated
08/19/2016
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