Provider Demographics
NPI:1538689740
Name:SHROTRIYA, SHIVA (MD, LMSW)
Entity type:Individual
Prefix:
First Name:SHIVA
Middle Name:
Last Name:SHROTRIYA
Suffix:
Gender:M
Credentials:MD, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 SERVICE RD STE A202
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-975-9500
Mailing Address - Fax:517-975-9520
Practice Address - Street 1:3520 FOREST RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3720
Practice Address - Country:US
Practice Address - Phone:517-975-9500
Practice Address - Fax:517-975-9520
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301502250207R00000X
MI43001113226208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine