Provider Demographics
NPI:1861401812
Name:SHAW, BINA B (MD)
Entity type:Individual
Prefix:DR
First Name:BINA
Middle Name:B
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BINA
Other - Middle Name:BHARAT
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1712 PICADILLY DRIVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084
Mailing Address - Country:US
Mailing Address - Phone:248-643-1953
Mailing Address - Fax:248-643-1953
Practice Address - Street 1:1712 PICADILLY DRIVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:248-643-1953
Practice Address - Fax:248-643-1953
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4203128OtherBCBS OF MICHIGAN
MI1105026991Medicaid
ON10700Medicare ID - Type Unspecified
MI1105026991Medicaid