Provider Demographics
NPI:1710983812
Name:SHAH, ASHWIN H (MD)
Entity type:Individual
Prefix:DR
First Name:ASHWIN
Middle Name:H
Last Name:SHAH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SANTURE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-4128
Mailing Address - Country:US
Mailing Address - Phone:734-241-3900
Mailing Address - Fax:734-241-3538
Practice Address - Street 1:730 N MACOMB ST
Practice Address - Street 2:STE 319
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162
Practice Address - Country:US
Practice Address - Phone:734-241-3900
Practice Address - Fax:734-241-3538
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043074208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3405810232OtherBCBS
MI104595322Medicaid
MI02011OtherPARAMOUNT
OH0514942OtherPALMETTO GBA OHIO CLAIMS
P00114142OtherPALMETTO GBA
OH0514942OtherPALMETTO GBA OHIO CLAIMS
MI0P11380Medicare ID - Type UnspecifiedTRENTON
MI104595322Medicaid