Provider Demographics
NPI:1043266547
Name:SHUKLA, YOGESH J (MD)
Entity type:Individual
Prefix:DR
First Name:YOGESH
Middle Name:J
Last Name:SHUKLA
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 1:2976 CHAMBORD DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3517
Mailing Address - Country:US
Mailing Address - Phone:248-626-7430
Mailing Address - Fax:
Practice Address - Street 1:13087 E 11 MILE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4782
Practice Address - Country:US
Practice Address - Phone:586-754-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010415292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0631231Medicare ID - Type Unspecified
MIB44486Medicare UPIN