Provider Demographics
NPI:1619363264
Name:SHAH, SABIN GUNJAN (MD)
Entity type:Individual
Prefix:
First Name:SABIN
Middle Name:GUNJAN
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11012 E 13 MILE RD STE 112
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2546
Mailing Address - Country:US
Mailing Address - Phone:586-573-8890
Mailing Address - Fax:
Practice Address - Street 1:11012 E 13 MILE RD STE 210
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2547
Practice Address - Country:US
Practice Address - Phone:556-582-0760
Practice Address - Fax:586-582-5729
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301502067207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery