Basic Information
| Provider Information | |||||||||
| NPI: | 1649891664 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHRIVASTAVA | ||||||||
| FirstName: | ASHISH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4201 ST. ANTOINE | ||||||||
| Address2: | UHC 9C | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137455146 | ||||||||
| FaxNumber: | 3139660880 | ||||||||
| Practice Location | |||||||||
| Address1: | CHILDREN'S HOSPITAL OF MICHIGAN 3901 BEAUBIEN ST | ||||||||
| Address2: | PEDIATRIC EDUCATION OFFICE 3RD FLOOR MAIN HOSPITAL 3T72 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137451892 | ||||||||
| FaxNumber: | 3139937118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2020 | ||||||||
| LastUpdateDate: | 09/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.