Provider Demographics
NPI:1528837218
Name:PROSPERITY MEDICAL, PLLC
Entity type:Organization
Organization Name:PROSPERITY MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RIDDHI
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-263-0167
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-0546
Mailing Address - Country:US
Mailing Address - Phone:516-263-0167
Mailing Address - Fax:
Practice Address - Street 1:3901 STONEGATE PARK STE 300
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9136
Practice Address - Country:US
Practice Address - Phone:269-408-4265
Practice Address - Fax:269-556-6020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROSPERITY MEDICAL, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty