Basic Information
| Provider Information | |||||||||
| NPI: | 1598952269 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JYOTIKA P SHETH MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30400 TELEGRAPH RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | BINGHAM FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480254537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483539460 | ||||||||
| FaxNumber: | 2483538084 | ||||||||
| Practice Location | |||||||||
| Address1: | 30400 TELEGRAPH RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | BINGHAM FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480254537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483539460 | ||||||||
| FaxNumber: | 2483538084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2007 | ||||||||
| LastUpdateDate: | 09/01/2009 | ||||||||
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| AuthorizedOfficialLastName: | SHETH | ||||||||
| AuthorizedOfficialFirstName: | JYOTIKA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2483539460 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1606390482 | 01 | MI | BCBSM | OTHER | 1606390482 | 01 | MI | BLUE CARE NETWORK | OTHER | 160F343380 | 01 | MI | BCBSM | OTHER | 1062483 | 05 | MI | MEDICAID |